Epidural dexamethasone reduces postoperative pain and analgesic requirements after major gynecological operations

ABSTRACT

Epidural steroids may have potential advantages for providing postoperative analgesia. This study was done to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following major gynecological operations. In a randomized, double-blind study, 75 patients undergoing major gynecological operations were randomly assigned to three equal groups. Group I [control] patients received dexamethasone 5mg iv with epidural injection of 0.25% bupivacaine 8ml and normal saline 2ml, Group 2 [D[1]] patients received normal saline 2ml iv with epidural injection of 0.25% bupivacaine 8ml and dexamethasone 5mg in normal saline 2ml, and Group 3 [D[2]] patients received normal saline 2ml iv with epidural injection of dexamethasone 5mg in normal saline 10ml. After surgery, morphine 2-4mg iv was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale [VAS] pain scores at rest and with effort, and time to first analgesic administration were recorded. Total morphine consumption for the first 24 hours following surgery was significantly lower in both epidural dexamethasone groups [D[1], D[2]] compared to the control group [p<0.05]. The percentage reduction in morphine consumption in Group D[1] was 56.9% and Group D[1] was 51.4% in the first 24 hr. Postoperatively at 12 hr, 18 hr, 24 hr, the VAS scores at rest and during effort were also significantly lower in the epidural dexamethasone groups [D[1], D[2]] compared to the control group [p < 0.05]. Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following major gynecological operations