Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis

Jebaraj, Bright; Khanna, Puneet; Baidya, Dalim Kumar; Maitra, Souvik

doi:10.4103/1658-354x.179096

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…Epidural dexamethasone in dose range of 4-8 mg has also been investigated for its analgesic efficacy and a recent meta-analysis has looked at its effectiveness[ 151 ]. The meta-analysis showed the advantages of the use of dexamethasone as an adjuvant to epidural local anaesthetics.…”

Section: Discussionmentioning

confidence: 99%

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Adjuvants to local anesthetics: Current understanding and future trends

Swain

Nag

Sahu

et al. 2017

WJCC

195

138

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Although beneficial in acute and chronic pain management, the use of local anaesthetics is limited by its duration of action and the dose dependent adverse effects on the cardiac and central nervous system. Adjuvants or additives are often used with local anaesthetics for its synergistic effect by prolonging the duration of sensory-motor block and limiting the cumulative dose requirement of local anaesthetics. The armamentarium of local anesthetic adjuvants have evolved over time from classical opioids to a wide array of drugs spanning several groups and varying mechanisms of action. A large array of opioids ranging from morphine, fentanyl and sufentanyl to hydromorphone, buprenorphine and tramadol has been used with varying success. However, their use has been limited by their adverse effect like respiratory depression, nausea, vomiting and pruritus, especially with its neuraxial use. Epinephrine potentiates the local anesthetics by its antinociceptive properties mediated by alpha-2 adrenoreceptor activation along with its vasoconstrictive properties limiting the systemic absorption of local anesthetics. Alpha 2 adrenoreceptor antagonists like clonidine and dexmedetomidine are one of the most widely used class of local anesthetic adjuvants. Other drugs like steroids (dexamethasone), anti-inflammatory agents (parecoxib and lornoxicam), midazolam, ketamine, magnesium sulfate and neostigmine have also been used with mixed success. The concern regarding the safety profile of these adjuvants is due to its potential neurotoxicity and neurological complications which necessitate further research in this direction. Current research is directed towards a search for agents and techniques which would prolong local anaesthetic action without its deleterious effects. This includes novel approaches like use of charged molecules to produce local anaesthetic action (tonicaine and n butyl tetracaine), new age delivery mechanisms for prolonged bioavailability (liposomal, microspheres and cyclodextrin systems) and further studies with other drugs (adenosine, neuromuscular blockers, dextrans).

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Section: Discussionmentioning

confidence: 99%

“…The meta-analysis showed the advantages of the use of dexamethasone as an adjuvant to epidural local anaesthetics. However, it also highlighted the need of further well powered studies to establish its safety in terms of neurological complications[ 151 ].…”

Section: Discussionmentioning

confidence: 99%

Adjuvants to local anesthetics: Current understanding and future trends

Swain

Nag

Sahu

et al. 2017

WJCC

195

138

View full text Add to dashboard Cite

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“…Similar results were obtained in humans with preoperative administration of dexamethasone (8 mg) given by epidural route providing analgesic effects in patients undergoing abdominal hysterectomy 11 . Patients who received epidural dexamethasone either alone or combined with bupivacaine had a longer duration of postoperative analgesia and less analgesic consumption compared to a control group that received IV dexamethasone and epidural bupivacaine 17 .…”

Section: ■ Discussionmentioning

confidence: 99%

“…In humans, lumbar epidural dexamethasone has been used to treat patients with postoperative pain resulting from lower abdominal surgeries 10,17 , hysterectomy 11 or orchiopexy and back pain 1,18,19 . The authors are unaware of any studies on the use of epidural dexamethasone in dogs to relieve pain and increase the duration of action of the lignocaine local anaesthetic in the postoperative period.…”

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confidence: 99%

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Hermeto

Rossi²,

Bicudo³

et al. 2017

Acta Cir. Bras.

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Purpose: To evaluate the postoperative analgesic and adverse effects of three doses of dexamethasone, administered epidurally in combination with lignocaine, in dogs undergoing ovariohysterectomy (OVH). Methods: Twenty-four female dogs undergoing ovariohysterectomy were pre-medicated with acepromazine and general anaesthesia was induced and maintained with propofol. Animals were randomly allocated into four groups of six. The control group was given lignocaine 2% (LI) and the treatment groups were given lignocaine with either 2 mg dexamethasone (LIDEX2), 4 mg dexamethasone (LIDEX4) or 8 mg dexamethasone (LIDEX8) administered at the lumbosacral epidural space. Duration of postoperative analgesia, first analgesic rescue, motor blockade, heart rate, blood pressure, respiratory rate, and rectal temperature were evaluated. Results: The duration of postoperative analgesia was 19.5 (SD 6) hours for LIDEX8 (p=0.001), 10 (SD 2) hours for LIDEX4 (p=0.002), 4 (SD 2) hours for LIDEX2 (p=0.074) treatments compared with values for the LI control treatment 2.2 (SD 1.6) hours. All treatments had significant cardiovascular and respiratory alterations but they were within acceptable range in these clinically healthy female dogs. Conclusion: Dexamethasone added to epidural lignocaine significantly extends the postoperative analgesia after ovariohysterectomy in female dogs.

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“…The half-life of dexamethasone is between 36 and 54 h, and its effects are most apparent in the first 48 h [ 1 ]. Dexamethasone as an adjuvant to epidural local anesthetics has been studied [ 12 ]. To date, no trial has reported neurotoxicity attributable to dexamethasone dosage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 4 mg dexamethasone versus 8 mg dexamethasone as an adjuvant to levobupivacaine in fascia iliaca block-a prospective study

2018

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BackgroundTo compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery.MethodsA total of 60 patients (age 18–70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block.ResultsThe duration of analgesia was found to be significantly longer in Group H (17.02 ± 0.45 h) than in the Group L patients (14.29 ± 0.45 h) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity.ConclusionsDexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.

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Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis

Cited by 16 publications

References 27 publications

Adjuvants to local anesthetics: Current understanding and future trends

Adjuvants to local anesthetics: Current understanding and future trends

The effect of epidurally administered dexamethasone with lignocaine for post-operative analgesia in dogs undergoing ovariohysterectomy. A dose-response study

Comparison of 4 mg dexamethasone versus 8 mg dexamethasone as an adjuvant to levobupivacaine in fascia iliaca block-a prospective study

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