EFFECT OF ADDING DIFFERENT DOSES OF DEXAMETHASONE TO BUPIVACAINE ON INTRATHECAL ANESTHESIA IN CESAREAN SECTION

Abstract

Background: The cost-effectiveness and facility in the administration have been made the spinal anesthesia as the most used technique in cesarean section. However, the short-term duration of local anesthetic drugs’ action has created a matter of concern for anesthesiologists. The purpose of this investigation was to evaluate the effect of different doses of dexamethasone conjugated with bupivacaine on the duration of spinal anesthesia as the primary outcome, and their adverse effects were examined among patients underwent cesarean section as well. Subject and Methods: In the current double-blind clinical trial, 90 pregnant women scheduled for cesarean section were randomly assigned into three groups after taking written consent. Patients assigned to the group A (n=30) received intrathecal bupivacaine 12.5mg (2.5 ml) of 0.5% hyperbaric bupivacaine diluted in preservative free normal saline (1 ml), group B (n=30): received 12.5 mg (2.5 ml) of 0.5% intrathecal hyperbaric bupivacaine and 2 mg (0.5 ml) preservative free dexamethasone, diluted in preservative free normal saline (0.5 ml), overall 3.5 ml volume intrathecally, and group C (n=30): received 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and 4 mg (1 ml) preservative free dexamethasone, overall 3.5 ml volume intrathecally. Results: In the present study the crude mean age of the patients was 26.49±5.49 (range: 1840 years) and the patients’ age, weight, and body mass index were comparable among three groups (p>0.05). The study showed the sensory block (min) in patients was significantly higher in groups 2 and 4 mg dexamethasone; 284.63±64.85 and 313.37±70.53, respectively compared to the control or group control, 165.33±44.95 minutes. Similarly, the motor block (min) in patients assigned groups 2 and 4 mg dexamethasone was substantially higher; 223.43±52.67 and 227.20±47.17, respectively in comparison with it’s in group control, 126.33±34.62 minutes. However, the difference between groups 2 and 4 mg dexamethasone not substantial for both sensory and motor blocks (p>0.05). The patients of three groups had not substantial difference in frequency of post-operative adverse effects, including postopetaive nausea & vomiting, hypotension, bradycardia, shivering, post-dural-puncture headache. Conclusions: administration of 2 or 4 mg dexamethasone intrathecally prolongs the duration of sensory and motor block of bubivacaine substantially in patients underwent cesarean section under spinal anesthesia and the effect of adding 2 mg on the duration of sensory and motor blocks is same like adding 4 mg. Duhok Med J 2018; 12 (1): 73-83.