الفهرس 
Epidural levobupivacaine versus a combination of levobupivacaine and dexamethasone in parturients receiving epidural for vaginal delivery analgesia :A comparative, dose ranging and safety evaluation study
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Abstract
Objective: to compare the effectiveness of epidural levobupivacaine alone versus a combination of levobupivacaine with dexamethasone in dose ranging and safety evaluation in normal labor analgesia. Subjects and Methods: This prospective double-blind trial included 90 primigravidas during vaginal delivery with a cervical dilatation {u2265} 4 cm and 50% effacement randomly assigned to one of three equal groups; group I: Epidural levobupivacaine 0. 125% in normal saline in a total volume of 15 ml(group L) group II : Epidural levobupivacaine in normal saline combined with dexamethasone 4 mg in a total volume 15 ml (group LD4) group III : Epidural levobupivacaine 0.125%in normal saline combined with dexamethasone 8 mg in a total volume 15 ml (group LD8) . At first request of analgesia, a 10 ml of 0.125% levobupivacaine was administrated via the epidural catheter. Further analgesia was provided with 10 ml 0.25% levobupivacaine hourly. The primary outcome measure was the duration of epidural analgesia. Secondary outcome measures include time from epidural analgesia to delivery, total amount of epidurally administered levobupivicaine, adverse effects of neuraxial block and neonatal outcome. Results: The duration of epidural analgesia was significantly longer (p < 0.05) when add dexamethasone to levobupivacaine . Total epidural levobupivacaine consumption was significantly lower (p = 0.05) in group LD4 and group LD8. The three groups were comparable in hemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects. Conclusion: epidural dexamethasone plus levobupivacaine prolongs the duration of epidural analgesia during the management of labor pain with hemodynamic stability and limited maternal and neonatal adverse effects