Comparing the Effectiveness of Dexamethasone, Fentanyl and Morphine as Adjuvants to Intrathecal Bupivacaine for Postoperative Pain in Elective Lower Limb Orthopaedics Surgery at Addis Ababa Public Hospital 2022/2023. Prospective Cohort Study
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Date
2023-06-12
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Addis Ababa University
Abstract
Postoperative pain management during lower limb surgery remained a serious issue despite advances in surgical approach, anesthetic modality, and pain therapy. Spinal anesthesia is the most commonly used anesthetic technique for pain control during orthopedic surgery. The main drawback of spinal anesthesia with bupivacaine is that it only provides analgesia for a brief period of time. Opioids like fentanyl and morphine are commonly used as adjuvants with local anesthetics, while steroids like dexamethasone have lately been studied as an intrathecal adjuvant to lessen disadvantages of spinal anesthesia.
Objectives: The main aim of this study was to compare analgesic effectiveness intrathecal morphine versus intrathecal dexamethasone, and intrathecal fentanyl as adjuvant to heavy bupivacaine for management of post orthopedic surgery pain in Addis Ababa hospitals from Dec 1, 2022 to Feb 28, 2023.
Methodology: A hospital based multicenter prospective cohort study was employed on 87 patients who undergone elective lower limb orthopedics surgery under SA fulfilling the inclusion criteria. Those who had received bupivacaine with dexamethasone were grouped as (BD-group), those who received bupivacaine with fentanyl were grouped as (BF- group) and those who received bupivacaine with morphine were grouped as (BM- group). The participants in the study were selected by systematic random sampling technique. Data was collected by preoperative chart review, intraoperative observation and postoperative patient interview. The data was entered into SPSS version 20 and analysis of variable was undertaken by using one-way ANOVA, Kruskal- Wallis H- rank test, and ᵡ2 test.
Result: The median numerical rating scale score was significantly lower in BD group during early 8 hours after surgery compared to BF group and BM group. The average duration for the first analgesic request was substantially shorter in the BF group compared to the BD and BM groups.; (367.9±65.64), (702.1±72.09), and (667.07±75.3) minutes respectively (p < 0.001). The total tramadol consumption was significantly lower in BD group 50(45-80) compared to BF group 75(55-100) and BM group 70(55-80) with (p<0.05).
Conclusion and Recommendation: Use of dexamethasone and Morphine as adjuvant with intrathecal bupivacaine are effective analgesic techniques for lower limb orthopedic surgery for prolonging analgesic period, reducing postoperative pain score and analgesic consumption. We recommend the use of intrathecal dexamethasone with heavy bupivacaine as an alternative to morphine for managing postoperative pain during lower limb surgery in resource limited area.
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Intrathecal Adjuvants, dexamethasone, opioids, post-orthopedic pain