The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy

Effectiveness of perineural administration of dexamethasone with lidocaine on onset time of sensory block and early postoperative analgesia in axillary brachial plexus block: a prospective cohort study, Ethiopia

Introduction

The axillary brachial plexus block is a popular nerve block for forearm, wrist, and hand surgery. The aim of this study was to assess the effectiveness of perineural administration of dexamethasone as an adjunct to lidocaine with adrenaline on the onset of sensory block and early postoperative analgesia in trans-arterial axillary brachial plexus block.

Methodology

This single-centered prospective cohort study recruited 68 adult patients, 34 in each groups. The frequently used 8 mg dexamethasone combined with 1% lidocaine and adrenaline was investigated. The normality of the data was checked using the Shapiro-Wilk test. An independent t-test was used to compare the mean values of symmetric numeric data. Categorical variables between the two groups were analyzed using χ2. The Mann-Whitney U test and Kaplan-Meier method using the log-rank test were used to compare asymmetric numeric data, and a P-value of <0.05 was considered as significant.

Results

The median onset time of sensory block was comparable between the nonexposed (24(6) min) and exposed group (24(6) min) (P=0.068). However, the duration of sensory block was significantly longer in the exposed group (235.5±37.51 min) than the nonexposed group (172.76±28.19 min) (P<0.001). The time to the first analgesic request was significantly longer in the exposed than the nonexposed group (P<0.01). Postoperative pain scores were significantly lower at 4 and 8 h in the exposed group (P<0.05).

Conclusion and recommendations

The addition of 8 mg dexamethasone to 1% lidocaine with adrenaline solution in trans-arterial axillary brachial plexus block for ambulatory elective hand, wrist, and forearm surgeries prolonged the duration of sensory blockade and the first analgesic request time but did not reduce the onset time of sensory block. The authors recommend the addition of 8 mg dexamethasone to 1% lidocaine with adrenaline solution to prolong the duration of sensory block and the first analgesic request time.

Dexamethasone in anesthesia practice: A narrative review

Dexamethasone is routinely used in anesthesia practice and has been regarded as one of the ideal perioperative agents. It is a synthetic glucocorticoid with potent antiinflammatory action. It reduces postoperative nausea and vomiting, pain, postoperative opioid requirements after general anaesthesia as well as spinal anaesthesia. It has been used via intravenous, epidural and perineural routes. It has been used successfully in fascial blocks. It significantly decreases fatigue, shivering and postoperative sore throat and improves quality of recovery.

The Effect of Dexamethasone on Postoperative Pain in Patients After Laparoscopic Cholecystectomy

Objectives The objective of the study was to determine the effect of a single dose of IV dexamethasone on postoperative pain in patients after laparoscopic cholecystectomy. The outcome will be measured in the terms of mean pain score. Study design and setting This is a prospective study. We did a randomized control trial to compare the outcome in two groups. This study was conducted in the Department of Surgery, Benazir Bhutto Hospital, Rawalpindi, from December 2021 to May 2022. The total duration of the study was six months. Methodology A total of 160 patients were randomly divided into group A and group B. We performed laparoscopic cholecystectomies on all the patients under standard general anesthesia. In group A (control group), 5 mL of normal saline was injected intravenously at the time of induction of anesthesia. In group B, the dexamethasone group, the inj. dexamethasone with a dose of 0.1 mg/kg diluted in 5 mL normal saline was given intravenously at the time of induction of anesthesia. Postoperatively, the median pain score was measured using visual analog scale (VAS) at 2, 6, 12, and 24 h on a specially made proforma. The results were further stratified according to gender and age. Results The postoperative VAS in group B was significantly low compared with group A when measured at 2, 6, 12, and 24 h. It means that the median pain score was markedly less in the study group than in the placebo one, and it was statistically significant (p<0.05). Conclusion Administration of a single dose of dexamethasone preoperatively in laparoscopic cholecystectomy patients is effective to control postoperative pain.

Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy

Background

Despite all of the benefits provided by laparoscopic cholecystectomy, such as rapid recovery and shorter hospital stay for patients, the incidence of postoperative nausea and vomiting (PONV) and postoperative pain (POP) still remains high.

Objectives

This study was designed to compare the effects of intraperitoneal (IP) and intravenous (IV) dexamethasone on the reduction of PONV and POP.

Methods

This prospective, randomized, double-blind clinical trial was conducted on a study population of 86 adult patients who were scheduled for laparoscopic cholecystectomy with the American Society of Anesthesiologists class I-II. The patients were randomized into three groups, namely IP dexamethasone (n = 29), IV dexamethasone (n = 29), and control (n = 28) groups. The patients were followed for clinical outcomes, including PONV, POP, and consumption of antiemetics, and their hemodynamic status during the first 24 hours after the surgery.

Results

In the first 24 hours after the operation, no significant differences were observed in nausea (P = 0.41) and vomiting (P = 0.38) between the IP and IV dexamethasone groups. However, there was a lower severity of nausea in the IP group (P = 0.001). Additionally, the visual analog scale score representing POP was significantly reduced in the IP group (P = 0.02). No significant differences in the hemodynamic status were observed after the operation between all the three groups.

Conclusions

The administration of 8 mg IP dexamethasone was associated with significantly reduced pain and severity of nausea, but not PONV, after laparoscopic cholecystectomy.

Parecoxib Shortens the Duration of Acute Postoperative Pain After Laparoscopic-Assisted Vaginal Hysterectomy

The effect of parecoxib sodium on the duration and severity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy has been inadequately studied. This randomized, controlled trial compared the effects of parecoxib, methylprednisolone, and placebo on the duration of acute postoperative pain after elective laparoscopic-assisted vaginal hysterectomy. Ninety-four eligible patients were randomized to three groups [parecoxib sodium 40 mg (Group P), methylprednisolone 1 mg/kg (Group M), and saline (Group S)]. The duration of pain during coughing [median (interquartile range)] was significantly lower in Group P than in Group M or Group S [26.0 (5.8–48.0) vs. 48.0 (30.0–55.5) vs. 48.0 (36.0–58.5) h; p = 0.025]. The duration of pain during rest was also significantly lower in Group P than in Group M or Group S [5.5 (3.8–21.0) vs. 24.0 (6.0–28.0) vs. 22.0 (5.8–36.0) h; p = 0.009]. Compared with those in Group M and Group S, the patients in Group P reported less intense visceral pain during coughing at 12 (p = 0.050) and 24 h (p = 0.009) as well as at rest at 12 h (p = 0.008). Compared with those in Group P and Group S, the patients in Group M showed lower serum C-reactive protein levels and higher blood glucose levels after surgery. No differences were noted in nausea, vomiting, length of hospital stay, wound infection, and delayed wound healing among the groups. Thus, parecoxib sodium reduces the duration and intensity of acute postoperative pain after laparoscopic-assisted vaginal hysterectomy.

Anesthesia considerations and post-operative pain management in pregnant women with chronic opioid use

The prevalence of opioid use disorder in pregnancy has escalated markedly in recent years. Chronic opioid use during pregnancy poses several challenges for providing adequate analgesia and anesthesia in the peripartum period. These challenges include the potential for withdrawal, opioid tolerance and opioid-induced hyperalgesia. Here we discuss alterations in analgesic pharmacokinetics and pharmacodynamics that are associated with chronic opioid use. In addition, when treating pain in patients with opioid use disorder it is important to distinguish between different subgroups. In this review, we will discuss practical management strategies for parturients with (1) untreated opioid use disorder, (2) parturients on medication-assisted treatment (methadone, buprenorphine) and (3) patients recovering from opioid use disorder that are currently abstinent. Finally, we offer an overview of non-opioid strategies that may be utilized as part of a multimodal approach to providing optimal analgesia in this patient population.

The effects of a combination of intravenous dexamethasone and ketamine on postoperative mood in patients undergoing laparoscopically assisted-gynecologic surgery

BACKGROUND

It has been known that anesthetic adjuvants such as dexamethasone or ketamine might change mood. This study aimed to investigate the effects of a single dose of each drug individually along with their combined usage on postoperative mood changes in patients undergoing gynecologic surgery.

METHODS

Two hundred ninety-seven patients randomly allocated were divided into three groups. Group K (n = 99) received a single dose of ketamine (0.5 mg/kg iv); group D (n = 99) received a single dose of dexamethasone (0.1 mg/kg iv), and group KD (n = 99) received both ketamine (0.5 mg/kg iv) and dexamethasone (0.1 mg/kg iv) at 5 min after the induction of anesthesia. A change in the patient health questionnaire (PHQ)-9 scores on the first and third day after surgery, the duration of anesthesia, the postoperative visual analog scale (VAS) for pain, and the patient controlled analgesia (PCA) consumption were evaluated.

RESULTS

Groups K and KD showed a significant reduction in PHQ-9 score on both the first and third day after surgery compared with those recorded preoperatively and in group D (P < 0.01). There were no differences in the group D PHQ-9 scores pre- and post-operatively. The VAS for pain 24 h after surgery and the PCA consumption in group KD decreased significantly compared to the other two groups (P < 0.05).

CONCLUSIONS

A single dose of ketamine (0.5 mg/kg) with or without combination with dexamethasone (0.1 mg/kg) give iv 5 min after induction of general anesthetic produced significant improvement in the postoperative mood scores. A single intravenous dose of dexamethasone (0.1 mg/kg) alone did not change postoperative mood scores. The VAS for pain 24 h after surgery and the PCA consumption was significantly lower in patients who received combination of both drugs.

A Narrative Review of the Evidence on the Efficacy of Dexamethasone on Postoperative Analgesic Consumption

OBJECTIVES

The effect of dexamethasone on analgesic consumption has not been adequately studied. The aim of this review was to investigate recent literature regarding the possible effect of dexamethasone on postoperative analgesic consumption.

METHODS

Critical review of randomized trials and prospective consecutive studies investigating the postoperative analgesic effect of dexamethasone was performed. Only studies published during 2006 to 2015 were included.

RESULTS

Forty-one studies met the inclusion criteria; 33 in adults and 8 in children (9 in general surgery, 8 in gynecologic/breast surgery, 8 in orthopedic/spinal surgery, 8 in head/neck surgery, 7 in children's tonsillectomy, and 1 in children's orchiopexy). Literature review demonstrated that dexamethasone can decrease analgesic requirements in patients undergoing laparoscopic cholecystectomies, laparoscopic gynecologic and breast surgery; whereas there is no consensus regarding orthopedic procedures, with positive evidence mostly regarding spinal surgeries. The efficacy of dexamethasone during head and neck surgery is not conclusive; however, its use before thyroid surgery may be beneficial. In children a beneficial impact of dexamethasone administration was revealed on posttonsillectomy reduction of analgesic needs. Studies on other kinds of operations in children are lacking.

CONCLUSIONS

Dexamethasone administered at a dose of 8 mg before surgical incision may be beneficial in laparoscopic cholecystectomies, thyroid, laparoscopic gynecologic and breast surgery, and tonsillectomies in children. Dexamethasone's potential impact on reducing postoperative analgesic requirements should be investigated in more detail in a systematic manner, to support its use in other kinds of operations.

Impact of duloxetine and dexamethasone for improving postoperative pain after laparoscopic gynecological surgeries: A randomized clinical trial

Background

Patients' surgical experiences are influenced by their perception of pain management. Duloxetine (Dulox) and dexamethasone (Dex) are used in multimodal analgesia to reduce opioid use and side effects. Dulox is a selective serotonin and norepinephrine reuptake inhibitor and has efficacy in chronic pain conditions. Dex enhances postoperative (PO) analgesia and reduces PO nausea and vomiting (PONV).

Methods

Seventy-five female patients were randomly allocated into one of three equal groups. GI received Dulox 60 mg orally and 100 ml 0.9% sodium chloride (normal saline [NS]) intravenous infusion (IVI) over 15 min, GII: received as GI except Dex 0.1 mg/kg was mixed with NS and GIII received identical placebo for Dulox capsule and Dex IVI, 2 h preoperatively. Patients' vitals, visual analog scale (VAS), and sedation score were assessed at 30 min, 1 h, 2 h, 6 h, and 12 h postoperatively. Total pethidine requirements, plasma cortisol, PONV, and patients satisfaction were recorded.

Results

PO time for 1^st rescue analgesic was significantly high in GI and GII compared to GIII and in GII compared to GI. There was a significant less VAS score, heart rate, mean arterial pressure, and a high sedation score in GI and GII compared to GIII at 30 min, 1, 2, and 6 h postoperatively. Total pethidine requirements were significantly less in GI and GII compared to GIII 12 h postoperatively. There was a significant reduction in the 2 h PO serum cortisol (μg/dl) and a significant increase in the PO patients satisfaction score in GI and GII compared to GIII. PONV was decreased significantly in GII compared to GI and GIII.

Conclusion

The use of oral Dulox 60 mg combined with Dex 0.1 mg/kg IVI is more effective than oral Dulox 60 mg alone, 2 h preoperatively, for improving PO pain by reducing the requirements for rescue analgesia and PONV.

The Effect of Single-dose Intravenous Dexamethasone on Postoperative Pain and Postoperative Nausea and Vomiting in Patients Undergoing Surgery under Spinal Anesthesia: A Double-blind Randomized Clinical Study

Background:

The use of neuraxial anesthesia has dramatically increased. Acute postoperative pain is an undesirable outcome that can delay functional recovery for patients undergoing surgery. Nausea and vomiting in the postoperative period occurs in 20%–30% of the patients and together are the second-most common complaint reported (pain is the most common). Efficacy of glucocorticoids for reducing pain and inflammation after surgery is being explored. Glucocorticoids are strong anti-inflammatory agents, which can be used for a short-time postoperative pain control in various surgeries. Dexamethasone is a glucocorticoid with little mineralocorticoid effect commonly used perioperatively to reduce postoperative nausea and vomiting (PONV) and has a beneficial role in postoperative analgesia. Dexamethasone has also an antiemetic effect, in addition to its anti-inflammatory and analgesic effects.

Aim:

The main purpose of this study is to evaluate the effect of administration of single-dose intravenous (i.v.) dexamethasone on postoperative pain and PONV in patients undergoing surgery under spinal anesthesia.

Settings and Design:

A double-blind randomized clinical study was performed in our institute between November 2014 and October 2015 after obtaining clearance from the ethical committee.

Materials and Methods:

A double-blind randomized clinical study was performed on 60 patients posted for surgery under spinal anesthesia. Patients were randomly assigned into two groups: A (study: 2 ml [8 mg] dexamethasone) and B (control: 2 ml saline). In both the groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate, severity of pain (based on visual analog scale), and other symptoms such as nausea and vomiting were recorded at different time points during the first 24 h after surgery. Statistical methods using Student t-test (two-tailed, independent) and Fischer's exact test were used for analyzing the data.

Results:

Between-group comparisons indicated significant differences in terms of severity of postoperative pain and PONV (P < 0.001), MAP (P = 0.063), and HR (P = 0.071), which in the study group were lower than the control group.

Conclusion:

i.v. dexamethasone is efficient in reducing postoperative pain, requirement of rescue analgesia on the first postoperative day, and incidence of PONV with no significant changes in vital signs.

Efficiency and safety of ketamine for pain relief after laparoscopic cholecystectomy: A meta-analysis from randomized controlled trials

OBJECTIVE

This meta-analysis aims to evaluate the effectiveness of intravenous infusion of ketamine for pain control after laparoscopic cholecystectomy (LC).

METHODS

A systematic search was performed in PubMed (1966-2017.08), Medline (1966-2017.08), Embase (1980-2017.08), ScienceDirect (1985-2017.08) and the Cochrane Library. Only randomized controlled trials (RCTs) were included. Meta-analysis was performed using Stata 11.0 software.

RESULTS

A total of six RCTs were retrieved involving 294 patients. The present meta-analysis showed that there were significant differences between groups in terms of visual analogue scale scores at 12 h (WMD = -0.478, 95% CI: -0.934 to -0.021, P = 0.040), 24 h (WMD = -0.550, 95% CI: -1.099 to -0.002, P = 0.049), and 48 h (WMD = -0.350, 95% CI: -0.678 to -0.021, P = 0.037) after LC. Significant differences were found regarding opioid consumption at 12 h (WMD = -2.820, 95% CI: -5.170 to -0.470, P = 0.019), 24 h (WMD = -3.816, 95% CI: -7.155 to -0.478, P = 0.025), and 48 h (WMD = -2.210, 95% CI: -4.046 to -0.375, P = 0.018) after LC.

CONCLUSION

Intravenous ketamine infusion significantly reduced postoperative pain scores and opioid consumption after LC. In addition, there were fewer adverse effects in the ketamine groups. Higher quality RCTs are still required for further research.

Analgesic Effect of Preoperative Pentazocine for Laparoscopic Cholecystectomy

Objective: To assess whether preoperative pentazocine can reduce intraoperative hemodynamic changes and postoperative pain.

Methods: Fifty patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group P received intravenous 0.5 mg/kg pentazocine 10 min before surgery, and Group C received normal saline as a placebo. A standardized general anesthesia was conducted in all patients. Mean blood pressure (MBP), heart rate (HR), and visual analog scale (VAS) scores at various time points were recorded. The tramadol consumption during the study period was recorded.

Results: Group P had lower VAS scores at two, four, and eight hours postoperatively compared with Group C. MBP and HR rose significantly because of pneumoperitoneum within Group C, and no significant changes were detected in MBP and HR within Group P. Tramadol doses given were statistically fewer in Group P.

Conclusion: Preoperative intravenous pentazocine can decrease intraoperative hemodynamic changes and postoperative pain.

The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery

Background

Surgery on the lower impacted third molar usually involves trauma in the highly vascularized loose connective tissue area, leading to inflammatory sequelae including postoperative pain, swelling, and general oral dysfunction during the immediate post-operative phase. This study aimed to investigate the effectiveness of preoperative injection of a single dose of 8 mg dexamethasone for postoperative pain control in lower third molar surgery.

Methods

A controlled, randomized, split-mouth, prospective study involving lower third molar surgery was performed in 31 patients. The randomized sampling group was preoperatively injected, after local anesthesia, with a single dose of dexamethasone (8 mg in 2 ml) through the pterygomandibular space; 2 ml of normal saline (with no dexamethasone) was injected as a placebo.

Results

The pain VAS score was significantly different on the day of the operation compared to the first post-operative day (P = 0.00 and 0.01, respectively), but it was not significantly different on the third and seventh postoperative day between the control and study groups. There was a significant reduction in swelling on the second postoperative day, and a difference between the second postoperative day and baseline value in the study group (P < 0.05). Trismus was highly significantly different on the second postoperative day and between baseline and second postoperative day between the groups (P = 0.04 and 0.02, respectively). Descriptive statistics and independent-samples t- test were used to assess the significance of differences.

Conclusions

Injection of 8 mg dexamethasone into the pterygomandibular space effectively reduced the postoperative pain and other postoperative sequalae.

Effect of Hydroalcoholic Leaves Extract of Rhus Coriaria on Pain in Male Rats

BACKGROUND

The drive toward the use of medicinal plants has been increasing in recent years. They have few side effects and a large variety of efficient components.

OBJECTIVES

This study was designed to investigate the analgesic effects of hydroalcoholic Rhus coriaria leaf extract (HRCLE) in a rat model.

MATERIALS AND METHODS

A total of 42 adult male rats were divided into seven groups: a control group (the animals did not receive any drug), three HRCLE groups, (receiving 80, 100, and 300 mg/kg, intraperitoneally [ip]), a morphine group (1 mg/kg, ip) an aspirin group (1 mg/kg, ip), and a group that received 300 mg/kg of HRCLE plus naloxone (1 mg/kg, ip). The analgesic effects of HRCLE were assessed via writhing, tail flick, and formalin tests, and the data obtained were compared with the control group using one-way analysis of variance and Tukey post hoc tests.

RESULTS

HRCLE significantly inhibited the number of contractions induced by acetic acid in the writhing test at all doses, while anti-nociceptive activity was only shown at the 100 mg/kg dose (in the chronic phase) and at the 300 mg/kg dose (in the chronic-acute phase) in the formalin test. Interestingly, the greatest effect was observed at the 300 mg/kg HRCLE dose in the tail flick test. Simultaneous utilization of naloxone and HRCLE inhibited the anti-nociceptive effect of the extract in all tests. It is worth mentioning that aspirin and morphine revealed anti-nociceptive effects in all tests.

CONCLUSIONS

Our findings suggest that the analgesic effect of HRCLE may be mediated via both peripheral and central mechanisms. The presence of flavonoids might be responsible for the anti-nociceptive activity of this plant.

Effect of preemptive analgesia with intravenous oxycodone in the patients undergoing laparoscopic resection of ovarian tumor

Objective:

To evaluate the efficacy of preemptive intravenous oxycodone in the patients undergoing laparoscopic resection of ovarian tumor.

Methods:

Sixty ASA I or II patients undergoing elective laparoscopic resection of ovarian tumor were randomly allocated to one of two groups: Group O (n=30) received intravenous oxycodone (0.1 mg·kg^-1) 10 minutes before surgery over 2 minutes, and Group N (n=30) received an equivalent volume of normal saline. All patients received a standardized general anesthesia. MBP and HR at the time of arrival of the operating room (T1), 5 min before pneumoperitoneum (T2), 5 minutes (T3), 10 minutes (T4), and 15 minutes after pneumoperitoneum (T5), and VAS scores at postoperative 2, 4, 8, 12 and 24 hour were recorded. The tramadol consumption and side effects in 24 h after surgery were recorded.

Results:

VAS pain scores at 2, 4, 8 and 12 hour after operation were significantly lower in Group O (P<0.05). MBP and HR increased significantly due to pneumoperitoneum at T3, T4 and T5, compared with T1 and T2 within Group N, and were higher at T3, T4 and T5 in Group N than at the same time points in Group O. Tramadol consumption was statistically lower in Group O (P=0.0003).

Conclusions:

Preemptive intravenous oxycodone was an efficient and safe method to reduce intraoperative haemodynamic effect and postoperative pain.