RESUMO
Number of studies revealed that epidural bupivacaine-dexamethasone has the same analgesic potency as bupivacaine-fentanyl with opioid sparing and antiemetic effects. Different doses of dexamethasone were used in different studies. This study was designed to evaluate the optimum dose of epidural dexamethasone for post-operative analgesia. In this double-blinded randomized controlled study, we evaluated the efficiency and safety of different doses of epidural dexamethasone for post-operative analgesia in 160 patients aged 45-60 years scheduled for total abdominal hysterectomy. Patient were randomly allocated into four groups to receive a total volume of 10 ml epidural plain bupivacaine 0.25% in the control group [Group D0] with either 4 mg dexamethasone in [Group D4] or 6 mg dexamethasone in [Group D6] or 8 mg dexamethasone in [Group D8]. Patients then received general anesthesia. Sedation, satisfaction and visual analog pain scores [VAS] at rest and with effort were measured post-operatively. Meperidine was administered when VAS > or = 4. Intra-operative fentanyl dose, post-operative meperidine consumption and the time to first analgesic requirement were recorded by a blinded observer. Blood glucose was measured pre-operatively and at 4 h and 8 h after study drug administration. Wound healing and infection were assessed after 1 week. Intraoperative fentanyl requirements were comparable among groups. The time to first analgesic requirement was significantly prolonged 5.5 times in D8 Group but only 1.5 times in D6 and D4 Groups more than the analgesic duration in the control Group D0, with a P < 0.01. There was a significant reduction in post-operative meperidine consumption during the first 24 h in the D8 [75%] in comparison with D6 and D4 Groups [50%], respectively, [P < 0.01] and the control Group D0 [0%] [P < 0.01]. VAS scores were significantly lower and patient satisfaction score was significantly higher in the D8 and compared with Groups D6 and D4 [P < 0.01] and the control Group D0 [P < 0.01]. Post-operative nausea was significantly lower in the D8, D6 and D4 Groups versus the D0 Group [P < 0.05]. Epidural dexamethasone in a dose of 8 mg is probably more effective than lower doses to control moderate to severe post-operative pain. This dose is not associated with increased glucose level or delayed wound healing
RESUMO
Gabapentin is effective for treating different types of headache including post-dural puncture headache [PDPH], also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section [CS] under spinal anesthesia. Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 microg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale [VAS] for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group [P < 0.05]. Also, severity and duration of headache were significantly less in gabapentin group [P < 0.05]. The incidence of sedation was more in gabapentin group 11 [26.19%] versus placebo group 3 [6.81%]. Neonatal outcomes were statistically insignificant between both groups. Pre-operative administration of gabapentin has no effect on incidence of [PDPH] but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby