Online ISSN: 2515-8260

Keywords : dexamethasone


AN OBSERVATIONAL STUDY OF THE EFFECT OF DEXAMETHASONE PROPHYLAXIS ON POST-OPERATIVE NAUSEA AND VOMITING IN PATIENTS FOLLOWING TOTAL ABDOMINAL HYSTERECTOMY UNDER COMBINED SPINAL EPIDURAL BLOCK

DR. SADIA UMMER, DR. S. KAMALUDEEN, DR. K. CHERAN

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 299-306

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.

Effect of addition of 8 mg of dexamethasone to 15 ml of 0.25% levobupivacaine in ultrasound guided adductor canal block for postoperative analgesia in patients undergoing knee surgeries

Dr. Priyadharshini S., Dr. Subbulakshmi Sundaram, Dr. T. Santhosh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3463-3472

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).

Comparison of intrathecal magnesium sulphate and dexamethasone in spinal anaesthesia as an adjuvant to hyperbaric bupivacaine in lower abdominal surgeries

Dr. U Sankara Rao, Dr. G Avinash

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 3074-3079

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.

A comparative study of dexmedetomidine and dexamethasone as adjuvants to ropivacaine in supraclavicular brachial plexus block

B Vani Prapurna, V Sudharani, S Kiran Kumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 54-60

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.
 

Comparison of Effectiveness of Dexamethasone and Dexmedetomidine as an Adjuvant in Plexus Block by Supraclavicular Approach

Archana Gautam, Reji S Varghese

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 5, Pages 252-257

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.

A CLINICAL COMPARISON BETWEEN EFFICACY O 0.5%LEVOBUPIVACAINE AND 0.5% LEVOBUPIVACAINE WITH DEXAMETHASONE 8 MG COMBINATION IN BRACHIAL PLEXUS BLOCK BY THE SUPRACLAVICULAR APPROACH

Dr. Anil, Dr.Gouthami, Dr.Padmavathi, Dr Mary .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4940-4950

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.

Comparison of Analgesic Effect of a Single Dose of PerineuralRopivacaine With and Without Dexamethasone on Ultrasound-Guided Femoral Nerve Block After Total Knee Arthroplasty

Dr. Rajmohan Rao Tumulu, Dr. Dilshad Kauser, Dr. Sunil Kumar Swain, Pranay Kumar Tumulu, Tanisha Garg, Mohammed Amer Mohiuddin

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 4696-4701

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.

Evaluation of The Efficacy of Dexmedetomidine And Dexamethasone When Used As Adjuvant To Ropivacaine In Supraclavicular Brachial Plexus Block for Upper Limb Surgeries

Dr Abhilash Dash; Dr Rabi Narayan Dhar; Dr Ramakanta Mohanty; Dr Sidharth Sraban Routray; Dr Soumyakant Mallick

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 6, Pages 1166-1173

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

Effectiveness of Dexamethasone for Acute Respiratory Distress Syndrome (ARDS) due to Coronavirus: A Systematic Review

Tri Setyawat; Ari Setiyawan Nugraha; Sarifuddin .

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 8, Pages 206-211

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.