EFFECT OF DEXAMETHASONE AS AN ADJUVANT ON THE DURATION OF POSTOPERATIVE ANALGESIA FOLLOWING ULTRASOUND GUIDED BILATERAL ERECTOR SPINAE PLANE BLOCK USING BUPIVACAINE IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA
Main Article Content
Keywords
Erector spinae Plane Block, Dexamethasone, Laparoscopic surgeries, postoperative analgesia, Paracetamol, PONV, Bupivacaine
Abstract
Background
Laparoscopic surgeries are associated with acute pain in the postoperative period, which maybe: somatic, visceral and referred thereby delaying postoperative recovery. Erector spinae plane block (ESPB) acts by blocking the dorsal and ventral rami of nerves supplying the anterior abdominal wall. Dexamethasone is an adjuvant that prolongs duration of action of local anesthetics (LA) by reducing inflammatory response. We studied the effect of dexamethasone used as an adjuvant to Bupivacaine on the duration of analgesia when used for USG guided ESPB during Laparoscopic surgeries.
Methods
After obtaining IEC clearance and CTRI registration, a prospective randomized double blinded study was conducted in 2 groups of 50 patients each, aged ≥ 18 years belonging to ASA 1 and 2 undergoing laparoscopic surgeries. Group B patients received USG guided B/L ESPB with Bupivacaine 0.25% 20 mL+ NS 1 mL each side. Group D patients received USG guided B/L ESPB with Bupivacaine 0.25% 20 mL+ Dexamethasone 1mL(4mg) each side. The duration of analgesia in the postoperative period was assessed using VAS score at 2nd hourly intervals up to 24 hours postoperatively. Complications if any were noted.
Results
The mean total duration of analgesia in Group B was 445±42.3 minutes and in Group D was 668±39.8 minutes. Mean difference in total duration of analgesia was 223± 55.13 min (95% CI 207, 239 Range 120, 360 min) (p<0.001) which is statistically significant. Median total dose of paracetamol (PCT) needed 24 hours in Group B 2[2, 2] and Group D was 1[1,1] with, (p<0.001) which is statistically significant. There were no complications in either group.
Conclusion
USG guided B/L ESPB with Dexamethasone as an adjuvant to Bupivacaine 0.25% 20 mL was found to significantly prolong the duration of analgesia with significant reduction in paracetamol (PCT) dose requirement postoperatively. There was minimal incidence of post operative nausea and vomiting (PONV).
References
2. Ibrahim M. Erector spinae plane block in laparoscopic cholecystectomy, is there a difference? A randomized controlled trial. Anesth Essays Res 2020;14:119-26.
3. Park YJ, Chu S, Yu E, Joo JD. Comparison of the efficacy of erector spinae plane block according to the difference in bupivacaine concentrations for analgesia after laparoscopic cholecystectomy: a retrospective study. J Yeungnam Med Sci 2023;40(2):172-8.
4. Tulgar S, Kapakli MS, Senturk O, Selvi O, Serifsoy TE, Ozer Z. Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial. J Clin Anesth 2018;49:101-6.
5. Altıparmak B, Korkmaz Toker M, Uysal AI, Kuşçu Y, Gümüş Demirbilek S. Ultrasound-guided erector spinae plane block versus oblique subcostal transversus abdominis plane block for postoperative analgesia of adult patients undergoing laparoscopic cholecystectomy: Randomized, controlled trial. J Clin Anesth. 2019;57:31-6.
6. Kwon HM, Kim DH, Jeong SM, Choi KT, Park S, Kwon HJ, Lee JH. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect? A Randomized Controlled Trial. Sci Rep 2020;10(1):8389.
7. Daghmouri MA, Akremi S, Chaouch MA, Mesbahi M, Amouri N, Jaoua H, Ben Fadhel K. Bilateral erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A systematic review and meta-analysis of randomized controlled trials. Pain Practice: The Official Journal of World Institute of Pain 2021;21(3):357–65.
8. Yang X, Zhang Y, Chen Y, Xu M, Lei X, Fu Q. Analgesic effect of erector spinae plane block in adults undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. BMC Anesthesiol. 2023;23(1):7.
9. Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial. Saudi J Anaesth 2012;6(3):229-33.
10. Gao Z, Xiao Y, Wang Q, Li Y. Comparison of dexmedetomidine and dexamethasone as adjuvant for ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: a randomized, double-blind, placebo-controlled trial. Ann Transl Med 2019;7(22):668.
11. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017;72(4):452-460.
12. Ragupathy, Ramanarayanan; Prabhu, S.C.Ganesh; Thiyagarajan, Dhivya; Anto, Vijay. Opioid-free anaesthesia for laparoscopic surgeries - a prospective non-randomised study in a tertiary care hospital. Indian Journal of Anaesthesia 2022;66(3):207-12.
13. Gao Y, Liu L, Cui Y, Zhang J, Wu X. Postoperative analgesia efficacy of erector spinae plane block in adult abdominal surgery: a systematic review and meta-analysis of randomized trials. Front Med (Lausanne) 2022.
14. Magdy Mohammed Mahdy, Essam Ezzat Abdelhakeem, Ayman Mohamed Fawzy & Mostafa Samy Abbas. Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy, Egyptian Journal of Anaesthesia, 2023;39(1):528-37.
15. Pani, S., Routray, S. S., Mohanty, R., & Pradhan, K. Evaluation of efficacy of ultrasound guided erector spinae plane block and oblique subcostal transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy. Panacea Journal of Medical Sciences 2020;10(2):128-34.
16. Badran MA, Kamaly AM, Abdel Hamid HM, et al. Dexamethasone as a bupivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a prospective randomized study. Ain-Shams J Anesthesiol 2020;12:61.
17. Alarasan AK, Agrawal J, Choudhary B, Melhotra A, Uike S, Mukherji A. Effect of dexamethasone in low volume supraclavicular brachial plexus block: A double-blinded randomized clinical study. J Anaesthesiol Clin Pharmacol 2016;32(2):234-9.
18. De Oliveira GS, Castro Alves LJ, Nader A, Kendall MC, Rahangdale R, McCarthy RJ. Perineural dexamethasone to improve postoperative analgesia with peripheral nerve blocks: a meta-analysis of randomized controlled trials. Pain Research and Treatment 2014;179029.
19. Arjun Chetan L, Nagaraj, Nagesh A, Babu N. Comparison of dexamethasone 4 mg and 8 mg as an adjuvant to 0.5% bupivacaine in supraclavicular brachial plexus block for upper limb surgeries- A randomised clinical study. Journal of Evolution of Medical and Dental Sciences 2019;8(41):3084-8.
20. Baeriswyl M, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth 2017;119(2):183-91.
21. Bheemanna NK, Nagaraj A, Appajigowda NM. Ultrasound guided bilateral erector spinae block with dexamethasone for post-operative analgesia in lumbar spine surgery: a case series. Archives of Anesthesia and Critical Care 2023;9(3) 211-4.
22. Mostafa SF, Abdelghany MS, Abdelraheem TM, Abu Elyazed MM. Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy: a prospective randomized controlled trial. Paediatr Anaesth 2019;29(12):1201-7.
23. Gultekin, MH, Erdogan A, Akyol F. Evaluation of the efficacy of the erector spinae plane block for postoperative pain in patients undergoing percutaneous nephrolithotomy: a randomized controlled trial. Journal of Endourology 2020;34(3):267-72.
24. Ramachandran S, Ramaraj KP, Velayudhan S, Shanmugam B, Kuppusamy S, Lazarus SP. Comparison of erector spinae plane block and local anaesthetic infiltration at the incision site for postoperative analgesia in percutaneous nephrolithotomy – a randomised parallel-group study. Indian J Anaesth 2021;65:398-403.
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Dr. Syed Adeeba Nousheen
Assistant Professor, Department of Anaesthesia, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.
Dr. Deepak Vijaykumar Kadlimatti
Associate Professor Department of Anaesthesia Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.
Dr. Nagashree J. Bharadwaj
Assistant Professor, Department of Anaesthesia, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.
Dr. Harsoor S.S.
Professor & HOD, Department of Anaesthesia, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.
Dr. Ankitha J. Hiremath
Postgraduate, Department of Anaesthesia, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.
Dr. Palla Sree Divya
Postgraduate, Department of Anaesthesia, Dr. B.R. Ambedkar Medical College & Hospital, Bangalore, Karnataka, India.