Efficacy of single-shot epidural with bupivacaine and dexamethasone as an adjuvant for postoperative analgesia in patients undergoing major abdominal surgeries

Background: Apart from being distressful, postoperative pain produces a range of harmful effects, including morbidity and mortality. Epidural analgesia is a safe and effective method for the control of postoperative pain. Aim: This study compared the analgesic efficacy of single-shot epidural bupivacaine plus dexamethasone versus single-shot epidural bupivacaine and intravenous (IV) dexamethasone after major elective abdominal surgery. Methodology: A cross-sectional cohort study was conducted on 30 adult patients undergoing major elective abdominal surgery. Fifteen minutes before the reversal of neuromuscular blockade, study Group “A” received an epidural of 0.125% bupivacaine at the dose of 1.0 mL/segment and dexamethasone 8 mg and Group “B” included data of 30 adult patients which was drawn from the well-matched historic cohort, from past anesthesia records, where patients received an epidural of 0.125% bupivacaine at the dose of 1.0 mL/segment, but an injection of dexamethasone 8 mg was administered intravenously. Results: The primary outcome was a significantly longer duration of analgesia (905.97 ± 110.89 min) in Group “A” patients in comparison to Group “B” patients (731.0 ± 112.59 min) (P < 0.0001). The secondary outcome included the requirement of total rescue analgesic dose of injection tramadol, which was significantly lower in Group “A” compared to Group “B” patients (163.90 ± 15.93 mg vs. 182.27 ± 30.61 mg, respectively), (P < 0.005). Postoperative nausea and vomiting incidence was lower in patients of Group “B” due to the antiemetic effect of IV dexamethasone. Conclusion: Single-shot bupivacaine with dexamethasone gives longer postoperative analgesia and lesser rescue analgesic requirement compared to epidural bupivacaine with IV dexamethasone.