Mohammad Ali1, Rina Akhter2, M A Jalil Barbhuiya3
1. Associate Professor, Department of Anaesthesia & ICU, North East Medical College, Sylhet, Bangladesh
2. Senior Consultant, Model Family Planning Clinic, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
3. Professor & Head, Department of Anaesthesia & ICU, North East Medical College, Sylhet, Bangladesh
Abstract
Regional anaesthesia is often the preferred technique for many gynaecological and genitourinary procedures. It provides excellent intra operative and post operative analgesia with decreased risk of respiratory and airway dysfunction. Spinal anaesthesia has the advantage that profound nerve block can be produced in a large part of the body by injecting a small amount of local anesthetic agent. Different additives are used to prolong the duration of spinal anaesthesia. The effect of corticosteroids in prolonging the analgesic effects of local anaesthetics in peripheral nerves is well documented. This randomized, prospective, case-control, clinical trial was performed with the aim to determine whether the addition of dexamethasone to intrathecal bupivacaine would prolong the duration of sensory analgesia or not. A total of 50 patients were scheduled for “Total abdominal Hysterectomy (TAH)” under spinal anaesthesia. The patients were randomly allocated to receive intrathecally, 20 mg hyperbaric bupivacaine 0.5% with 1 ml normal saline (control group) or 20 mg hyperbaric bupivacaine 0.5% with 4 mg (1 ml) dexamethasone (case group). All patients were evaluated for duration, quality and quantity of block. Blood pressure, heart rate, nausea-vomiting or other complications were also evaluated. No significant differences were found in demographic data, sensory level, and onset time of the sensory block between two groups. Sensory block duration in the case group and in control group was 119±10.69 minutes and 89.44±8.37 minutes respectively. It was significantly higher in the cate group (P<0.001). The duration of analgesia was 401.92±72.44 minutes in the case group: whereas wax 202±43.67 minutes in the control group (P<0.001). The frequency of complications was not significant in two groups. This study findings revealed that, dexamethasone in addition to intrathecal bupivacaine significantly improves the duration of sensory block in spinal anesthesia without any remarkable complications.
Keywords: Dexamethasone, sensory block, spinal anesthesia, bupivacaine.