SINGLE-SHOT EPIDURAL INJECTION OF A COCKTAIL OF LEVOBUPIVACAINE/DEXAMETHASONE AT THE TIME OF INDUCTION OF ANESTHESIA SPARES OPIOIDS DURING AND AFTER OPEN ABDOMINAL HYSTERECTOMY
Ahmed Said Elnoury1, Ahmed KM Zaineldin2, Ibrahim EM Mostafa1
1Department of Anesthesia & ICU, Faculty of Medicine, Benha University
2Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University
Objectives: The present study tried to evaluate the analgesic outcomes of epidural levobupivacaine (LB) alone or in combination with dexamethasone (DEXA) or neostigmine (Neo) injected as a single-shot at the time of induction of anesthesia for women undergoing open abdominal hysterectomy. Patients &Methods: 90 patients were divided into three groups according to the injected epidural drug. All patients received balanced sevoflurane anesthesia and the study drugs were injected at the time of induction of anesthesia. The total doses of the injected intraoperative (IO) fentanyl, and IO hemodynamic variables were recorded. Postoperative (PO) pain scores were determined using the Numerical Rating Scale (NRS) and PO morphine (5 mg) was given at NRS ≥4. Duration of PO analgesia was determined as time lapsed till recording NRS≥ and the total dose of PO morphine was recorded. Results: IO fentanyl and PO morphine doses consumed by patients of LB/DEXA and LB/Neo groups were significantly lower than patients of the LB group and the duration of analgesia was significantly longer with LB/DEXA and LB/Neo than LB with insignificant differences between DEXA and Neo but in favor of DEXA. Hemodynamic variables recorded during or after surgery showed non-significant differences between patients of the three groups. Conclusion: Epidural injection of a cocktail of LA and DEXA or Neo improved PO outcomes of women undergoing open abdominal hysterectomy concerning the duration of PO analgesia and IO and PO consumption of opioids. Combined LB/DEXA did more favorably than LB/Neo as regards these outcomes and is advocated for IO and PO analgesia for major surgeries.
December 2020