Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

Abstract

Background: Pain after laparoscopic bariatric surgeries has negative effects on patients' recovery. Objective: To evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative pain relief after laparoscopic bariatric surgeries. Patients and Methods: Sixty patients were randomly allocated into 3 groups as follows: Group B (n=20): bupivacaine 100 ml 0.25% + 5 ml normal saline. Group BD4 (n=20): bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) + saline 4 ml, and Group BD8: (n=20) bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml. Postoperatively ketorolac IV 30 mg/6 hours + Paracetamol IV 1 g/8 hours were given± nalbuphine. Results: Pain was lower in Group BD8. Sedation was deeper in Group B. Time to first supplementary analgesia was longer in Group BD8 than Groups B or BD4, and longer in Group BD4 compared to Group B. Patients requiring supplementary analgesia were less in Group BD8 than Groups B or BD4. Total postoperative consumption of nalbuphine in the first postoperative day (POD 1) was less in Group BD8 than Groups B or BD4, and less in Group BD4 than Group B. Time for independent ambulation was shorter in Group BD8 than Groups B or BD4, and shorter in Group BD4 than Group B. Postoperative nausea and vomiting (PONV) was higher in Group B compared to other groups. Conclusion: Intraperitoneal administration of either 4 mg or 8 mg dexamethasone to bupivacaine (0.25%) resulted in better recovery and pain relief after bariatric surgeries. Dexamethasone 8 mg is superior to 4 mg.

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Hysterectomy: A Randomized Controlled Trial

“…The total dose of Nalbuphine in the 1 st 24 hrs was significantly lower in in group III compared to group I and group II (P<0.001, 0.001) and was significantly lower in group II compared to group I (P=0.003). Nasr et al [14] performed a randomized clinical trial to evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative pain relief after laparoscopic bariatric surgeries. [11] performed a randomized prospective trial on a total of 100 patients scheduled for laparoscopic cholecystectomy (LC) who were randomized into two equal groups, group RD received 0.2% ropivacaine 30 ml plus 8 mg dexamethasone, and group RS received 0.2% ropivacaine 30 ml plus 2 ml normal saline intraperitoneally to evaluate the intraperitoneal ropivacaine with dexamethasone versus ropivacaine alone for pain relief after LC.…”

“…in Group B (Bupivacaine group) and versus (7.4 ± 0.55 hr.) in Group BD4 (Bupivacaine+ 8 mg dexamethasone group) (P<0.001), according to a previous study [14] . Based on the following considerations: 0.05 α error and 90% power of the study.…”

Analgesic efficacy of intra-peritoneal instillation of dexamethasone and bupivacaine versus bupivacaine following laparoscopic cholecystectomy – A randomised, double-blind controlled study

“…This finding aligns with the observation made by Nasr et al . [ 13 ], who reported that patients receiving intra-peritoneal bupivacaine with 8 mg dexamethasone had a significantly longer duration of analgesia 9.2 h (0.14) as compared to bupivacaine alone 6.1 h (0.19) following laparoscopic bariatric surgery.…”

“…In our study, the total rescue analgesic dose needed was significantly less in the BD group. Similar findings were noted by Nasr et al .,[ 13 ] who reported that patients receiving intra-peritoneal bupivacaine with dexamethasone consumed significantly less rescue analgesic 3.4 mg (2.8) compared to bupivacaine alone 15.2 mg (7.5) with P < 0.001 following laparoscopic bariatric surgery. Similarly, Srivastava et al .…”