Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial

Abstract

Background: Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery. Methods: A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h. Results: The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; P < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; P < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L. Conclusions: The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

“…Dexamethasone prolongs the analgesic effect of interscalene blocks in conjunction with ropivacaine or bupivacaine [103], supraclavicular blocks when mixed with lidocaine [104], bupivacaine or levobupivacaine [105] and when combined with lidocaine for axillary block [106]. Dexamethasone has also been shown to prolong the analgesic effect of levobupivacaine in quadratus lumborum [107] and transversus abdominis plane blocks [108]. A recent study, however, suggests that perineural dexamethasone does not provide any significant block‐related analgesic advantages over the intravenous route commonly used for anti‐emetic prophylaxis [109].…”

“…Dexamethasone has also been shown to prolong the analgesic effect of levobupivacaine in quadratus lumborum [107] and transversus abdominis plane blocks [108]. A recent study, however, suggests that perineural dexamethasone does not provide any significant block-related analgesic advantages over the intravenous route commonly used for anti-emetic prophylaxis [109].…”

Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: a prospective randomized non-inferiority clinical trial

“…Moreover, the optimal QLB approach in hepatectomy has not been established. It is conceivable that the use of adjuncts such as dexamethasone25 or epinephrine26 to prolong analgesia duration, or a continuous catheter technique, will lead to different outcomes. Another reason might be the differences in the mechanisms of action between the central neuraxial and the fascial plane blocks.…”

Opioid-free anaesthesia: The conundrum and the solutions

“…The prolongation of analgesia spares post-operative opioid use as well. [ 21 22 23 ] Regional anaesthesia reduces central sensitisation and improves long-term pain outcomes. [ 1 ]…”