European Journal of Molecular & Clinical Medicine

Back ground: When prophylaxis is not used, ENT operations have a significant incidence of postoperative emesis. Antiemetic use as a preventative measure may lower total PONV-related resource use and expenses, improving patient satisfaction. Numerous methods have been employed to reduce the incidence of PONV such as pharmacological interventions for prophylaxis, altering the anaesthetic technique, or combining them all for optimum protection. The present study was conducted with an aim to compare the effectiveness between propofol and dexamethasone in the prevention of postoperative nausea and vomiting after ear, nose and throat surgery and to study any adverse effects associated with these drugs.
Materials and methods: A total of 60 patients who underwent ENT surgeries were divided into two groups with 30 in each group. Group A received dexamethasone 8mg and Group B received propofol 0.5mg/kg after completion of surgery. The incidence and severity of PONV and associated adverse effects were documented at immediate post-op, 30 minutes, 1^{st -}, 6^{th -} , 12^{th -} , and 24^th- hour after the administration of study drug. In addition, the requirement of rescue antiemetics in the overall 24 hours was documented.
Results: There was no statistically significant difference between the dexamethasone and propofol groups in terms of age, gender, body mass index (BMI), type of surgery, ASA status, or duration of anaesthesia and surgery. Incidence of severe PONV (3.3% versus 12%, p =0.008) were statistically significantly lower in group A compared to patients in group B over the 6th-12thhour time period. The mean time to first nausea episode in group A was significantly more compared to group B (p<0.001).
Conclusions: Although the efficacy of dexamethasone and propofol in preventing post-operative nausea and vomiting in ENT surgeries are comparable dexamethasone produced better PONV protection than propofol.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of post-operative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Regional anaesthesia has been preferred over general anaesthesia in many orthopaedic surgeries due to lack of associated complications in regional blocks. Increasing the duration of local anaesthetic action can obtain the desired effect of prolongation of the postoperative patient comfort. Many adjuvants to local anaesthetics such as epinephrine, clonidine, opioids, dexmedetomidine and also neostigmine have been tried. Recently, dexamethasone has been found to prolong postoperative analgesia, reducing the requirement of the local anaesthetic and also the side effect profile. Hence our study was conducted to analyse the efficacy of dexamethasone as an adjuvant drug to levobupivacaine. After institutional ethical committee approval, CTRI registration and patient consent, a double blinded randomised controlled study was conducted in 50 patients aged 18-65 years of ASA I&II undergoing upper limb surgeries distal to mid-humeral level over a period of 1year. The mean duration of postoperative analgesia in Group D was 1022.2±62.67 minutes and in Group S was 777.40±34.19 minutes (p<0.001). The mean total dose of rescue analgesics required was more in Group S when compared to Group D in the first 24hrs. The onset of sensory and motor block was faster in Group D when compared to Group S. The mean duration of sensory and motor block was significantly longer in Group D than Group S. The addition of dexamethasone to levobupivacaine in SCBP blockade was associated with faster onset as well as prolonged duration of sensory and motor block, prolonged duration of post-operative analgesia and required less rescue analgesics.

Ultrasound guidance in anaesthesia is becoming an important tool in Anaesthesiologists. Sonography helps in addressing a variety of consequences such as patient safety, economic burden, duration of the procedure and success rates associated with invasive anaesthesia procedures. Consent from 50 patients were obtained in their own understandable language. After thorough pre-anaesthetic evaluation and overnight fasting, patients shifted to operation theatre and following monitors are connected. (Pulse oximeter, electrocardiogram, capnograph and non-invasive Blood pressure) Patients were randomly allocated into 2 groups (Group D and Group S) as per computer generated randomization table. The average diastolic blood pressure in both the groups was maintained from the baseline till 24 hours of observation. There was neither clinical nor statistical significant variation found. We did not find any clinical variations in the heart rate, SBP, DBP, MAP, RR of the patients preoperatively, intra and also postoperative period. All the recruited patients had maintained oxygen saturation >95% throughout the surgery.

Pain during the postoperative period has an impact on the quality of recovery and the length of hospital stay, which is a point of concern both for the surgeon and patients. Many modalities for reducing postoperative pain have been evaluated, with Lumbar paravertebral Block being associated with reduced postoperative pain, significantly reduced postoperative analgesic requirements.
Aim: The primary objective of the present study was to assess the analgesic effectiveness of Lumbar paravertebral block given with Ropivacaine alone and Ropivacaine with Dexamethasone (as adjuvant) for elective lower limb surgery.
Material and Methods: This was a single-centre, double blinded, hospital-based comparative observational study conducted among a total of 60 patients undergoing lower limb elective surgery given Lumbar paravertebral block given with Ropivacaine alone (30 patients) and Ropivacaine with Dexamethasone, as adjuvant (30 patients). Evaluation of Postoperative pain, with the first demand of analgesia and total analgesic required, was recorded.
Results: There was no statistically significant difference between the two groups regarding the distribution of age, weight, gender or BMI. The mean VAS score at 0,6, 12-, 24-, 36- and 48 hours after surgery among patients given lumbar paravertebral block with Ropivacaine alone was 0, 2.6, 4.1, 3.9 and 4.1, respectively. The mean VAS score at 0, 6, 12-, 24-, 36- and 48 hours after surgery among patients given Lumbar Paravertebral Block with Ropivacaine and Dexamethasone was 0, 1.1, 2.5, 3.4, and 3.6, respectively. The mean duration of the first request for analgesia was 14.6 hours and 19.2 hours among the patients given only Ropivacaine in comparison to those given both Ropivacaine + Dexamethasone (p<0.0001).
Conclusion: Lumbar paravertebral nerve block given with both Dexamethasone & Ropivacaine for elective lower limb orthopedic surgery improves postoperative analgesic quality and decreases the requirements of analgesia in comparison to patients given Ropivacaine alone.

Spinal anaesthesia using only local anaesthetics is associated with relatively short duration of action. Postoperative pain control is a major problem with spinal anaesthesia using only local anaesthetics alone, and thus early analgesic intervention is needed in postoperative period. Various adjuvants such as morphine, Opioids, Dexamethasone, Magnesium sulphate etc., have been studied to prolong the effect of spinal anaesthesia. This study is designed to compare the effect of adding Dexamethasone and magnesium sulphate to hyperbaric Bupivacaine in lower abdominal surgeries. Total of 80 adult patients aged between 18-50 years undergoing lower abdominal and lower limb surgeries. After institutional ethical committee approval, 80 patients aged between 18-50 years undergoing lower abdominal and lower limb surgeries are selected. Patient pain was assessed with VAS at 30 min post operatively and following results were observed. Mean VAS for D group was 4.5 and mean VAS for M group was 5.2. Hence it is observed that addition of Dexamethasone to bupivacaine had a better analgesic effect than Magnesium sulphate.

Postoperative vomiting or retching (POV) can lead to rare but serious medical complications, such as wound dehiscence, bleeding, electrolyte imbalance, dehydration and pulmonary aspiration of gastric contents. Hence the present study was planned to find out the effect of prophylactic dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing total abdominal hysterectomy under combined spinal epidural block. Influences of dexamethasone on patient satisfaction and postoperative analgesia were also observed as secondary objectives.
Methods: 110 female patients who are undergoing total abdominal hysterectomy were included in this observational study. Patients were divided into two groups. 54 patients in group A and 56 patients in group B. Group A received 8mg dexamethasone i.v along with premedication The primary outcome variable was to compare post-operative nausea and vomiting using numerical rating scale (NRS). Secondary outcome variable was visual analogue scale of post- operative pain and overall patient satisfaction.
Results: Age, height, weight, ASA and hemodynamic parameters were compared between the 2 groups but were statistically insignificant. The PONV scores were significantly lower in group receiving dexamethasone during 0.5, 6, 12, 24h postoperatively. The VAS score for post- operative pain was also significantly lower in group receiving dexamethasone. Over all patient satisfaction was much better in those receiving dexamethasone as part of premedication, the total analgesic requirement was also significantly lower. There were no complications.

Background: Adductor canal block (ACB) has recently been considered as a promising method for providing analgesia after knee surgeries with sensory blockade. ACB blocks the sensory innervation of the knee via the saphenous nerve ^[1]. ACB preserves quadriceps muscle strength better than Femoral Nerve Block, minimizing weakness during knee extension and thus functional recovery is improved within the first 24 hrs post‑operative period and the risk of developing Deep Vein Thrombosis is reduced ^[1]. Addition of Dexamethasone to local anaesthetics improves the quality and duration of peripheral nerve block ^[2]. We evaluated the effect of adding dexamethasone to levobupivacaine on the duration of postoperative analgesia in patients undergoing knee surgery using ultrasound-guided adductor canal block.
Methods: The study was a prospective double blinded randomized comparative study. Sixty patients scheduled for knee surgery were randomly allocated into two groups to receive adductor canal block. The control group L received 15 mL levobupivacaine 0.25% + 2 mL normal saline, and the dexamethasone group D received 15 mL levobupivacaine 0.25% + 2 mL dexamethasone (8 mg). Measurements included duration of sensory blockade, hemodynamic stability, visual analog score, time to first analgesic requirement and analgesic consumption.
Results: Postoperative analgesia was better in Group D patients. The mean VAS score increased with time and the magnitude of increase was more in the Group L than in group D. Duration of analgesia was significantly prolonged in Group D (14 ± 2.25 hours) when compared to Group L (10.57 ± 1.65 hours) with significant P value (<0.05). There was no significant difference between two groups in terms of age, sex, ASA grading and type of surgery. Both the groups maintained hemodynamic stability, which was statistically insignificant (P value >0.05).

Background: Supraclavicular brachial plexus block is a commonly employed regional nerve block technique for upper extremity surgery. Various adjuvants were added to local anaesthetics in brachial plexus block to achieve rapid onset and prolonged block. To compare dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic agent in supraclavicular brachial plexus block with respect to onset and duration of sensory and motor block and duration of blockade.
Material and Methods:Forty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block were divided into two equal groups in a double- blinded fashion. Group one was given 0.25% Bupivacaine 2 milligram/kg as local anaesthetic and Dexmedetomidine 1microgram/kg as adjuvant. Group two was given 0.25% Bupivacaine 2 milligram/kg and Dexamethasone 100microgram/kg as adjuvant. Onset and duration of sensory and motor blockade and hemodynamic stability were recorded. All patients were observed for any side effects and complications. All data were recorded and statistical analysis was done.
Results: Sensory block and motor block onset was earlier in dexmedetomidine group.The duration of blockade was also prolonged in dexmedetomidine group when compared with dexamethasone group and is not associated with any major side-effect.
Conclusion: Dexmedetomidine is a better adjuvant than dexamethasone in supraclavicular brachial plexus block.

Background: Enhancing the duration of sensory and motor blockade of regional anaesthesia is often desirable for prolonged surgeries and also provides pain relief in the immediate postoperative period. We performed a prospective, randomised, study to evaluate the effect of Dexmedetomidine and Dexamethasone as adjuvants to Ropivacaine in supraclavicular approach of brachial plexus block.
Study design: The study was a controlled, randomised, double-blinded, prospective study.
Methods: Sixty ASA physical status 1 and 2 patients undergoing elective hand, forearm and elbow surgeries under brachial plexus block were randomly divided to receive either 8 mg Dexamethasone + 30ml 0.5% Ropivacaine or 1 mcg/kg Dexmedetomidine + 30 ml 0.5% Ropivacaine. The block was performed using a nerve stimulator. Onset and duration of sensory and motor blockade and total duration of analgesia were measured. Vitals were recorded at 3, 5,10,15,30 and 45 minutes. Two sample ‘t’ test of difference between two means was used to analyse the differences between various parameters that were used in the cases. Categorical data was assessed by Chi square test and Fishers exact test. P value of < 0.05 was considered significant.
Results: The onset of sensory block and onset of motor block both were found to be sooner with Dexmedetomidine than Dexamethasone. The duration of sensory block and motor blockade and duration of analgesia was longer with Dexmedetomidine than Dexamethasone.
Conclusion: Both Dexmedetomidine and Dexamethasone enhanced the onset and duration of blockade but, the effect was found to be more pronounced with Dexmedetomidine.
 

Background: When used in conjunction with bupivacaine to block the supraclavicular brachial plexus (SCBP), dexamethasone prolongs the motor and sensory blockade. The effect of dexamethasone (8 mg) when combined with levobupivacaine, on the other hand, has not been well investigated.
Aim: To determine the role of dexamethasone as an adjuvant to levobupivacaine in ultrasound guided SCBP block.
Materials and methods: Comparison of efficacy of levobupivacaine and levobupivacaine with dexamethasone in supraclavicular brachial plexus block was undertaken to compare duration of analgesia, requirement of rescue analgesics and the onset and duration of sensory and motor block among 2 groups. Patients in age group 18 to 60 years belonging to either sex of ASA class 1 or 2 posted for upper limb surgeries were divided into 2 groups of 30 patients each. Group S: 25 ml of 0.5% Levobupivacaine + 2ml Normal Saline Group D: 25 ml of 0.5%Ropivacaine + 2ml (8mg) Dexamethasone.
Results: There was no statistically significant difference in demographic data, duration of surgery, and hemodynamic parameters between the study groups. There was statistically highly significant difference in between the groups in terms of onset and duration of sensory and motor block and duration of analgesia (time to first rescue analgesia) and total number of rescue analgesics used.
Conclusion: Addition of dexamethasone to 0.5% levobupivacaine shortens the onset of sensory and motor block and increases the duration of sensory and motor block as well duration of analgesia in comparison to levobupivacaine alone in Supraclavicular Brachial Plexus Block for upper limb surgeries.

Background:
Postoperative pain after total knee replacement surgery is an unpleasant memory for the patients.
Different techniques have been tried to elevate the post-operative pain. A femoral nerve block
with local anaesthetics is considered to bethe gold standard for postoperative pain.But the painfree
period after the femoral nerve block lasts for a few hours only.Several adjuvants have been
triedwith local anaestheticsto prolong analgesics’ duration and avoid the adverse effects of
NSAIDsandopioid use.
Objective:
In this study, we have used dexamethasone as an adjuvant withropivacaine to prolong the
duration of analgesia effect, in a single dose of perineural femoral nerve block after total knee
arthroplasty.
Methods:
It was a prospective, randomized, controlled study, sixty patients were randomly assigned to one
of two groups:Group R or Group RD. In Group R, 40 mL of 0.375% ropivacaine was used, and
in Group RD 8 mg of dexamethasone was used as an adjuvant to 40 mL of 0.375%
ropivacaine.The primary endpoint was to check the duration of analgesia after the femoral nerve
block and the secondary endpoint was to check the amount of rescue analgesic consumed in the
first 24 hours, postoperatively.A visualanalogue scale (VAS) score was used to access the pain
with 1 being the least pain and 10 being the highest. The adverse reactions to the drugs were also
noted in both groups.

We have done this trialin order to correlate analgesic dexmedetomidine (DXM) &dexamethasone (DX) efficacyin form of an additive for supraclavicular brachial plexus(SCBP)‘s ropivacaine blockage for upper extremity surgery. This is trial in which, 18–65 yrs 70 ASA status type one and two individuals suffering from disease, posted for upper extremity surgery was splitrandomly within couple of categories. Class DXMgot 2 mlof normal saline containing dexmedetomidine (1mcg/kg) with 0.5%ropivacaine(30 ml) and Class DXgot 2 ml(8 mg) of dexamethasone with 0.5%ropivacaine(30 ml). SCBP block was performed under ultrasonography(USG). The primary outcome was time of 1st analgesic request and no of analgesic request in 1st 24hrs. Secondary endresult of the trial were Motor block& sensory were secondary trial end result onset & time & incidence associated with drug’sside effects. Time for request of 1st rescue analgesia was 720.50±67.87min in Class DXM and 591.83±52.25min in Class DX. Total rescue analgesia required within post -operative for 1 dayinto DXM Class is less in comparison to DX Class. The mean of onset time of motor block& sensory into Class DXM is lesser in comparison to Class DX, which is statistically important. In Class DXM mean of duration of sensory block was 656.50± 50.58min, which was significantly longer than Class DX where duration was 534.10± 62.43min. Mean of motor block duration was 611.83± 45.3min in Class DXM and 470.83± 59.40min in Class DX (p<0.001). Dexmedetomidine provided prolonged relief from suffering after utilizing it in form of an additive to SCBP portion’s ropivacaine when compared to dexamethasone

Estimates have suggested that up to 12% of patients hospitalized with COVID-19 have required invasive mechanical ventilation, with the majority developing acute respiratory distress syndrome(ARDS). Corticosteroids are the most potent anti-inflammatory drugs. The therapeutic mechanism of corticosteroids might base on attenuating the action of many cytokines that participated in the inflammatory reaction associating severe CAP However, the clinical and efficacy of dexamethasone in COVID-19 patients are currently unclear, so research is needed to know the effectiveness of dexamethasone therapy in patients with COVID-19. This research uses a structured analysis focused on preferred reporting items for systematic reviews and meta-analyzes (PRISMA) in order to classify all existing literature with appropriate keywords. The database using PRISMA (Preferred Reporting Items for Systematic Reviews & Meta Analyses) for instruments and used flowcharts based on the 2009 PRISMA checklist and based on inclusion and exclusion criteria, we found that dexamethasone resulted in a significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days in patients with COVID-19 and moderate or severe ARDS.