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Abstract
Postoperative pain is one of the most common complaints after surgery and continues to be a challenge for anesthetists. Severe postoperative pain causes extreme discomfort, sleep deprivation and along with postoperative nausea and vomiting, is the main cause of delayed discharge.
The old idea that there is a class of drug, a ”universal analgesic” that can reduce all pain is now obsolete. Today, with the increasing understanding of the pain pathway and the processes involved in it, it is recognized that pain is best controlled by using several analgesic agents with different routes of administration , each of which acts on a specific site along the pain pathway. This approach is known as ”multimodal analgesia”.
The aim of the present study was to assess the role of epidural dexamethasone 6 mg in postoperative analgesia after upper abdominal operations and in decreasing the total dose of intravenous nalbuphine required in the first 24 hours postoperatively.
This study was carried out on sixty three patients admitted to the medical research institute hospital and scheduled for elective upper abdominal operations. Patients were between the ages of 20 to 60 years, ASA physical status I or II, of both gender and weighing between 50 and 80 kg were included in this study. Patients were randomly divided into three groups, each with 21 patients receiving the following epidural injection: - group I: bupivacaine.
- Group II: bupivacaine plus dexamethasone.
- Group III: dexamethasone.
The day before surgery, the procedure of epidural injection was explained to all patients. They were trained on how to use both the visual analogue scale and dynamic pain score. All patients were premedicated with 1- 2.5 mg midazolam intravenously ten minutes before surgery. 2 ug/kg fentanyl and 1 mg/kg lidocaine 2% were given intravenously just before induction of general anesthesia.
All patients received a single epidural injection (each patient according to his group) at thoracic level T7-8 or T8-9. Then, all patients received standardized general anesthetic technique: induction was carried out with thiopental sodium 3-5 mg/kg intravenously. Endotracheal intubation was facilitated by rocuronium 0.6 mg/kg then mechanical ventilation was instituted at a tidal volume of 6-8 ml/kg and a frequency of 12 breath/min. Maintenance of anesthesia was with isoflurane 1.2 - 2.4 % in a mixture of nitrous oxide and oxygen in a ratio of 6:4. Incremental doses of rocuronium 0.3 mg/kg were administered when needed. At the end of the operation, the residual muscle relaxation was reversed with atropine 0.015 mg/kg and neostigmine 0.04 mg/kg intravenously.