Epidural Dexamethasone for Postoperative Analgesia in Patients Undergoing Unilateral Inguinal Herniorrhaphy: A Comparative Study.

Background. This study was designed to evaluate the effect of adding dexamethasone to epidural bupivacaine on postoperative analgesia in unilateral inguinal herniorrhaphy. Methods. Forty-four patients were enrolled in this double-blind, clinical trial study. Patients were randomly allocated into dexamethasone or control group. In the dexamethasone group, patients received 18 ml of bupivacaine 0.5% and 2 ml (8 mg) of dexamethasone; in the control group, patients received 18 ml of bupivacaine 0.5% and 2 ml of normal saline. The onset of sensory block and its duration and incidence of nausea and vomiting were recorded. Results. The onset of epidural anesthesia was significantly more rapid in the dexamethasone group than in the control group (P < 0.001). Duration of analgesia was markedly prolonged in the dexamethasone group than in the control group (P < 0.001). Five patients (22.7%) in the control group had nausea in the first hour after the procedure (P = 0.048). None of the patients in the dexamethasone group had nausea. None of our patients had vomiting in the two groups. Conclusions. This study showed that adding dexamethasone to bupivacaine significantly prolongs the duration of postoperative analgesia. This trial is registered with Iranian Registry of Clinical Trials (IRCT) number IRCT2012062910137N1.

Retrobulbar versus topical anesthesia for phacoemulsification.

To evaluate and compare intraoperative pain, perioperative complications and hemodynamic changes during phacoemulsification under topical and retrobulbar anesthesia. A total of 564 patients were randomly allocated into topical and retrobulbar groups. All patients received 2 mcg kg(-1) fentanyl 5 min before the start of their procedures. Patients in the topical group were treated with tetracaine 0.5% eye drops and given preservative free lidocaine 2% intracamerally during surgery. Patients in the retrobulbar group received a 4 mL lidocaine 2% into the retrobulbar space. The number of complications, hemodynamic changes, phaco time and pain severity on the base of a 10-point visual analog scale of pain were recorded immediately after surgery. Differences between the 2 study groups in age, sex, postoperative visual acuity and phaco time were not statistically significant. Blood oxygen saturation, heart rate, systolic and diastolic blood pressure had no difference before and after surgery in the two groups (p > 0.05). Chemosis, periorbital hematoma and subconjunctival hemorrhage occurred only in the retrobulbar anesthesia group. Incidence of vitreous loss, corneal edema and zonular tear was not statistically significant in the two groups. Two hundred thirty five patients (83%) in the retrobulbar and 238 (84%) in the topical group reported minimal discomfort (0-2). The Mean +/- SD pain score in the topical group was 1.13 +/- 1.36 and in the retrobulbar group 1.14 +/- 1.47 (p = 0.92). Patients undergoing cataract surgery with topical anesthesia and those undergoing cataract surgery with retrobulbar block did not vary in terms of subjective pain score and other parameters measuring intraoperative pain, efficacy of anesthesia and feasibility of surgery. This suggests that cataract surgery can be performed with topical anesthesia without compromising the safety of the procedure.

The effect of dexamethasone on postoperative vomiting and oral intake after adenotonsillectomy.

OBJECTIVE: Vomiting is one of the most important postoperative complications of adenotonsillectomy. This study was designed to determine the effectiveness of preoperative intravenous dexamethasone on postoperative emesis. METHODS: In a double-blind, placebo-controlled clinical trial, 100 patients aged 5-15 years, ASA classes I and II were randomly selected to receive either 0.5 mg/kg IV dexamethasone (n=50), as study group or an equivalent volume of saline preoperatively, as control group. The anesthetic regimen and surgical procedures were standardized for all patients. The incidence of early and late vomiting, the time to first oral intake and duration of intravenous hydration were compared in both groups. RESULTS: Data analysis showed that the overall incidence of early and late vomiting was significantly lesser in dexamehasone group than the control one. The time to first oral intake and duration of IV therapy were also significantly shorter in dexamethasone group. CONCLUSION: A single dose of dexamethasone significantly decreased the incidence of postoperative vomiting in early and late recovery phase and shortened the time to first oral intake and the duration of IV therapy.