Suresh, J (2013) Comparing Efficacy of Epidural Dexamethasone Versus Fentanyl on Post Operative Analgesia: A Double Blinded Randomized study. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: The perioperative period is usually associated with a variety of pathophysiologic responses that are initiated or maintained by nociceptive input. Uncontrolled postoperative pain may produce various acute and chronic effects which may be detrimental to the patient. The perioperative pathophysiological changes that occurs during surgery can be attenuated through reduction of transmission of nociceptive input to the central nervous system by providing perioperative analgesia. This also • Decreases complications, • Facilitate recovery during the immediate postoperative period, • Improves long term recovery, • Reduces the length of hospital stay, • Improves the quality of life. Post operative pain management should be planned and tailored to the needs of special population like ambulatory surgical patient, elderly, paediatric, opioid tolerant, obese patients and those with obstructive sleep apnea syndrome. AIM OF THE STUDY: To compare the efficacy of epidural dexamethasone versus fentanyl on post operative analgesia. MATERIALS AND METHOD: After getting Ethical committee approval from Goverment Kilpauk Medical College Hospital. Chennai 10, we conducted the study in our hospital in 60 adult male patients aged between 25 – 45 years belonging to ASA Physical status I and II undergoing elective hernioplasty under epidural anesthesia after obtaining written informed consent. Study Design: Double blinded randomized prospective study. Patients were randomly allocated into one of the three groups (20 patients per group) by lotting method. Method of Blinding: Patients and the person performing the epidural technique was unaware of the epidural drug composition. The drug solution was prepared by an anaesthesiologist assistant in the operating room and was labelled accordingly. Patient Selection: All the 60 patients were evaluated clinically, biochemically and assessed for hernioplasty under epidural anesthesia considering the inclusion and exclusion criteria. Then the patients were randomised into three groups. Study Period: From onset of epidural blockade to onset of postoperative pain with VAS > 5. Observation Period: For 24 hours postoperatively. Inclusion Criteria: 1. Adult male patients aged 25 – 45 years, 2. ASA physical status I & II, 3. For uncomplicated inguinal hernia surgery. Exclusion Criteria : 1. Patient unwilling for the procedure, 2. Obese, 3. Hypertension, 4. Diabetes mellitus, 5. History of peptic ulcer disease, 6. Those received corticosteroids or immune suppressive drugs in the last 6 Months, 7. Those with contraindications to steroids, 8. Patients on anticoagulants, 9. Patchy or inadequate blockade which required supplemental narcotics or general anesthesia. Patient Groups: 60 patients enrolled in the study were randomly allocated into three groups. Group 1: Patients receiving 11 cc of 0.5 % bupivacaine plus normal saline 1 cc epidurally. Group 2: Patients receiving 11 cc of 0.5 % bupivacaine plus 50 μg fentanyl epidurally. Group 3: Patients receiving 11 cc of 0.5 % bupivacaine plus 4 mg preservative free dexamethasone epidurally. All patients received a total volume of 15 ml of study drug including 3 ml of test dose plus 1 ml of adjuvant. The level of blockade was then noted. Materials Used: 1. 16 Gauge Tuohy needle, 2. 18 Gauge epidural catheter, 3. Loss of resistance syringe, 4. 10 ml syringe, 5. Local anesthetic solution ( 3 ml of 0.5 % bupivacaine with epinephrine 1 in 2,00,000 dilution ) for test dose. 6. 0.5% bupivacaine, 7. Inj. Fentanyl, 8. Inj. Dexamethasone sodium phosphate (preservative free), 9. 22 g needle for pin prick test. SUMMARY: After getting ethical committee approval the study was conducted in 60 patients undergoing elective hernioplasty belonging to ASA physical status I & II. The 60 patients enrolled in the study were divided into three groups.The data were statistically analysed , compared and discussed. The results obtained were summarised below: 1. The demographic data like age, weight, height were comparable to each other in all the three group. 2. The onset of analgesia was significantly earlier in group 2 patients receiving fentanyl 5.075 min and the onset was delayed in dexamethasone receiving group 6.525 min . 3. The duration of analgesia was significantly prolonged in group 3 patients receiving dexamethasone 373 min when compared to group 2 patients receiving fentanyl 347.25 min. 4. None of the patients in group 3 receiving dexamethasone had nausea. The incidence of nausea in group 1 was 3.55 % and in group 2 patients was 20%. 5. None of the patients in group 1 and group 3 had pruritus but the incidence of pruritus in group 2 patients receiving fentanyl was 15%. 6. There is nil incidence of sedation in group 1 and group 3.There was more incidence of sedation in group 2 patients receiving fentanyl ( 25 %.) 7. The incidence of initial hypotension followed by epidural bolus was 10, 15, 20 % in group 1, 2 and 3 respectively which were comparable. This initial hypotension was treated with fluid bolus and single dose of inj. Ephedrine 6 mg IV. 8. There is nil incidence of any complications in all the study group. CONCLUSION: We conclude that epidural administration of dexamethasone – bupivacaine admixture resulted in better postoperative analgesia in terms of lower postoperative pain score, prolonged postoperative analgesia and patient comfort with fewer side effects when compared with the other two groups. We also conclude that this epidural dexamethasone resulted in prolonged postoperative analgesia without any side effects like nausea, vomiting, pruritus, sedation except hypotension in few patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparing Efficacy ; Epidural Dexamethasone ; Fentanyl ; Post Operative Analgesia ; Double Blinded Randomized study. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 01 May 2018 05:10 |
| Last Modified: | 01 May 2018 05:10 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7396 |
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