Preperitoneal postcesarean section bupivacaine analgesia: Comparison between dexamethasone and dexmedetomidine as adjuvants

Abstract

Background:The peritoneal wound is frequently neglected during laparotomy. The preperitoneal local anesthetics and many adjuvants were effective for postcesarean analgesia. Analgesia may involve somatic and autonomic components. The preperitoneal bupivacaine and the promising adjuvants dexamethasone or dexmedetomidine were compared in this study.Patients and Methods:Sixty patients subjected to a cesarean section (CS) under general anesthesia divided into two groups using a bolus of preperitoneal bupivacaine 0.7 mg/kg with either 1ug/kg dexmedetomidine (Group P) or 8 mg dexamethasone (Group D). The time to the first analgesic request was the primary outcome.Results:There was a significantly prolonged time to the first analgesic request in the Group P than the Group D and less required preperitoneal injections in the Group P, also pain assessed by Numerical Rating Scale (NRS) was lower in the Group P than the Group D after 6 h postoperatively up to 24 h.Conclusions:Dexmedetomidine provided better analgesia than dexamethasone as an adjuvant to preperitoneal bupivacaine post-CS.

Local Infiltration of Bupivacaine along the Incision Line following Cesarean Section reduces Postoperative Pain and Analgesia Requirement: A Double-blinded Randomized Controlled Study

“…The parietal peritoneum though pain sensitive was not anaesthetized and therefore postoperative pain control may be potentially suboptimal. 23 We did not include peritoneal spraying as the amount of BP absorbed from peritoneum is not well established. However, it has also been said that preperitoneal LA might not have added benefit over subcutaneous infiltration.…”

Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery

“…The study in which dexmedetomidine and dexamethasone were compared in prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy (the patients received either single dose of dexmedetomidine or dexamethasone before skin incision) demonstrated that the patients in dexmedetomidine group had lower severity of pain, higher sedation score, requested the first analgesic postoperatively later, and the amount of postoperative administrated tramadol was lower (41). Similarly, in the study in which dexmedetomidine and dexamethasone were compared as adjuvants to bupivacaine analgesia in preperitoneal post-cesarean section lower pain scores, prolonged time to first analgesic request was observed in dexmedetomidine group (42).…”

“…The proper tube position was confirmed by auscultation and fiberoptic bronchoscopy. The ventilation settings during surgery were tidal volume ( 7-10 mL kg -1 (ideal body weight) ), a fraction of inspired oxygen (0.5-1.0), and end-tidal CO 2 partial pressure (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Following surgery, patients were admitted to the Intensive Care Unit (ICU).…”