Comparative study between (Dexamethasone – Bupivacaine) versus (Magnesium sulfate - Bupivacaine) for postoperative analgesia

• Aim: This work aims to compare the postoperative analgesic effects and side effects of Dexamethasone or Magnesium sulfate (Mg) that added to bupivacaine. • Patient and Methods: Eighty patients aged between 16–70 years with ASA I– II who were scheduled for infra-umbilical surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:(Group A) 40 patients received 50mg magnesium sulphate added to2.5ml volume of 0.5% hyperbaric bupivacaine plus 0.5 ml Normal saline.(Group B) 40 patients received 4mg dexamethasone added to 2.5ml volume of 0.5% hyperbaric bupivacaine. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L2-3 or L3-4). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GA or GB).Immediately after administration; the patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed . • Results: Dexamethasone had a faster Onset of sensory block onset than Magnesium Sulphate; Dexamethasone had a longer duration of regard Duration of motor block than Magnesium Sulphate; Magnesium Sulphate group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .Conclusion: the addition of Dexamethasone 4mg or Magnesium Sulphate 50mg to intrathecally injected Bupivacaine improved the effect of Ahmad EL-Saied Abdel Rahman Ali*; Mohammed Abdel Rehem Mohammed**;Ahmed Hamody Hassan***and Haitham Sayed Mohammed**** PDF created with pdfFactory Pro trial version www.pdffactory.com SOHAG MEDICAL JOURNAL Comparative study between (Dexamethasone – Bupivacaine) Vol. 21 No.3 october 2017 Haitham Sayed Mohammed 590 local anesthetic (6). -Spinal anesthesia avoids the risks of general anesthesia such as aspiration of gastric contents and difficulty with airway management. (1). -However, postoperative pain control is a major problem because spinal anesthesia using only local anesthetics associated with relatively short duration of action, and thus early analgesic intervention is needed in the postoperative period ( 3). . -To improve the quality of central neuraxial block or spinal anesthesia, adjuvant drugs are used with local anesthetics. These drugs enhance or potentiate the actions of local anesthetics in order to improve the latency of the block, duration, and quality of analgesia. (1). -Opioids that are added intrathecally prolong the duration of anesthesia, but are associated with a number of undesirable side e ects like delayed respiratory depression, urinary retention, pruritis, nausea, and vomiting. . (1). -Drugs like dexmedetomidine, dexamethasone and magnesium sulfate have also been used successfully as an adjunct in spinal anesthesia along with local anesthetic (5). -It is known that Dexamethasone has anti-inflammatory and analgesic action by inhibition of transmission in nociceptive C-fibers and neural discharge. When given as an additive in peripheral nerve blocks or in intrathecal anesthesia, it prolongs the duration of anesthesia. (1). -Magnesium sulfate (Mg) improves postoperative analgesia after intrathecal administration as an effective adjuvant to bupivacaine by inhibits calcium entry into cells also involved in decreased catecholasmine release associated with sympathetic nerve stimulation during pain episode. . (7). Patients and Methods Eighty patients aged between 16–70 years with ASA I– II who were scheduled for infra-umbilical surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee.This Study was conducted in Sohag University Hospitals from August 2016 to March 2017.Patientswere excluded if they had a history of Opium addiction, sedative drugs consumption; Contraindication for spinal anesthesia, as sepsis, severe coagulopathy and severe heart disease.; Patient with long history of steroid use or Patient unable to communicate making postoperative assessment di cult. Patients were divided into 2 equal groups: (Group A) 40 patients received 50mg magnesium sulphate added to2.5ml volume of 0.5% hyperbaric bupivacaine plus 0.5 ml Normal saline. (Group B) 40 patients received 4mg dexamethasone added to 2.5ml volume of 0.5% hyperbaric bupivacaine. Then we did the followings: 1A venous access was secured using wide bore cannula and the patient was preloaded with lactated ringer solution (10 ml/kg) before the induction of the spinal anesthesia 2Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L2-3 or L3-4). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GA or GB). 3Immediately after administration, the patients were turned into the supine position PDF created with pdfFactory Pro trial version www.pdffactory.com SOHAG MEDICAL JOURNAL Comparative study between (Dexamethasone – Bupivacaine) Vol. 21 No.3 october 2017 Haitham Sayed Mohammed 591 4Patients were monitored by: Heart rate using ECG electrodes; NIBP Using NIBP Cable and Oxygen Saturation Using Pulse Oximetery. And baseline values were recorded. 5Observations: APatients were observed for onset, duration of sensory block bilaterally by using to pin prick with a short hypodermic needle BMotor blockade is assessed based on a modified Bromage scale: ̧ Grade 0 no paralysis, able to flex extended leg at hip; ̧ Grade 1 able to flex knee but not flex extended leg; ̧ Grade 2 able to move foot only; ̧ Grade 3 unable to move foot (Biswas et al; 2002) These tests were performed every 5min after the spinal block intra-operative and every 15 minutes postoperative for 3 hours until the sensory and motor variables were back to normal. CIntra operatively, the patients received 10 mL/Kg lactated Ringer solution.Systolic ;Diastolic Blood Pressure and Heart rate were recorded before spinal anesthesia and there after every 5 min until the end of the procedure and every 15 minutes for 3 hours DOxygen Saturation were recorded before spinal anesthesia and there after every 5 min until the end of the procedure EIn the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS) ranging from 0 (no pain) to 10 (maximal pain) every 15minutes for 3 hours. Visual Analogue Score (VAS): The VAS is validated approach to pain measurement; it consists of a 10-cm line with one end labeled “no pain” and the other end labeled “worst pain imaginable.” The patient marks the line at the point that best describes the pain intensity (Jensen 1993) FComplications: Nausea, vomiting, pruritus, shivering, desaturation or hypoxemia (SpO2 <90%), respiratory depression (RR < 10), bradycardia and hypotension were also noticed and treated accordingly. Statistical analysis Data was analyzed using STATA intercooled version 12.1. Quantitative data was represented as mean, standard deviation, median and range. Data was analyzed using student t-test to compare means of two groups. When the data was not normally distributed Mann-Whitney test was used. Qualitative data was presented as number and percentage and compared using either Chi square test or fisher exact test. Graphs were produced by using Excel or STATA program. P value was considered significant if it was