The effects of adding dexamethasone to epidural bupivacaine for lower limb orthopedic surgery

Introduction dexamethasone when given epidurally with local anesthetics is known to reduce postoperative pain and postoperative analgesic consumption in several types of surgical procedures. objective the objective of this study was to evaluate the effect of epidural dexamethasone on postoperative analgesia in patients who were undergoing lower limb orthopedic surgery. patients and methods it is a prospective, randomized, double‑blinded comparative study carried out in assiut university hospital, egypt. it included 50 patients divided into two equal groups (25 in each), who underwent lower limb orthopedic surgery. the saline group: who received 15 ml epidural plain bupivacaine (0.5%)+2 ml normal saline (bs) and the dexamethasone group: who received 15 ml epidural plain bupivacaine (0.5%)+8 mg dexamethasone (2 ml) (bd). postoperatively, when the pain score of at least 4, the rescue analgesia was given in the form of fentanyl and bupivacaine epidurally and paracetamol (perfalgan) 1 g was given routinely for all patients intravenous drip/8 h. pain was evaluated by visual analog scale every 4 h in the postoperative 24 h. time to first request for analgesia and total dose of rescue analgesia (epidural fentanyl/ bupivacaine) in the first, 24 h postoperative was recorded. results dexamethasone significantly reduced the first, 24 h postoperative pain score (visual analog scale), and postoperative epidural fentanyl consumption (70.00 vs. 43.40 μg) in the first, 24 h postoperative. dexamethasone also significantly prolonged the time to first request for analgesia (3.38 ± 0.072 vs. 15.24 ± 2.03 h). conclusion epidural dexamethasone with bupivacaine offers favorable effects on postoperative analgesia in lower limb orthopedic surgery.