European Journal of Cardiovascular Medicine

Objectives:The primary objective is to study the effect of epidural dexamethasone combined with bupivacaine on the duration of postoperative analgesia in patients undergoing total knee replacement surgery, compared to those who received only epidural bupivacaine. The effect of epidural dexamethasone on the patient's vital signs, such as heart rate and blood pressure, as well as its adverse effects like nausea, vomiting, headache, and back pain, are also studied. Methods:The study was conducted in the Department of Anaesthesiology at Government Medical College, Thiruvananthapuram. After obtaining clearance from the Institutional Research and Ethical Committee and obtaining informed written consent from the patients, subjects were assessed and categorized into ASA physical status classes (ASA 1 and 2). All consecutive cases meeting the eligibility criteria and undergoing total knee replacement under combined spinal epidural analgesia were enrolled in the study. The subjects were divided into two groups of 47 each. After completing the surgery, epidural analgesia was administered with 4 ml of 0.125% bupivacaine alone in the control group, and a combination of 4 ml of 0.125% bupivacaine and 8 mg of dexamethasone was given in the case group by the faculty. Patients were observed and followed up over 48 hours to monitor the duration of analgesia and the development of any complications. The onset of pain after analgesia was measured using the Visual Analog Scale. The time from the end of epidural analgesia administration until the first request for postoperative analgesia was recorded for each patient. All data, including demographic variables, vitals, surgical details, primary outcomes, and the incidence of adverse effects, were entered into a structured proforma and analyzed. Results:The duration of postoperative analgesia was significantly longer (P value-0.0001) in the case group, i.e., the patients who received epidural dexamethasone 8 mg along with 4 ml of 0.125% bupivacaine compared to the control group (10.36 vs. 5.15 hours). There was also a statistically significant (P value-0.001) decrease in heart rate in the patients receiving epidural dexamethasone when compared to the control group (68.49 vs. 73.11). The incidence of adverse effects like hypotension (12.8% vs. 17%) and bradycardia (8.5% vs. 10.6%) was comparable in both groups, reflecting a similar extent of sympathetic blockade in both groups. The incidence of other adverse effects like nausea and vomiting (4.3% vs. 10.6%), headache (6.4% vs. 8.5%), and back pain (8.5% in both groups) were also comparable in both groups. Conclusion:The addition of epidural dexamethasone to bupivacaine increased the duration of postoperative analgesia in patients undergoing total knee replacement surgery. It also caused a marginal decrease in heart rate, which was clinically insignificant.