Intravenous Dexamethasone As An Adjunct To Improve The Preemptive Analgesia By Local Anesthetic For Laparoscopic Cholecystectomy

Object:This prospective,randomized,double-blind trial compared the analgesic efficacy of the combination of intravenous dexamethasone and ropivacaine used in local anesthetic with ropivacaine alone for providing pain relief following Laparoscopic Cholecystectomy.Method:Patients were double blindly randomized and underwent elective 3-port laparoscopic cholecystectomy.The blank group?Group BK?received 50ml normal saline?iv?45min before the anesthesia,then peri-incisional?10ml?and intraperitoneal?20ml?normal saline before the surgery procedure.The normal saline group?Group NS?received 50ml normal saline?iv?,peri-incisional?10ml?and intraperitoneal instillation?20ml?of 0.5%ropivacaine.The Dexamethasone group?Group DEX?received 0.15mg.kg^-1 dexamethasone in 50ml normal saline?iv?,peri-incisional?10ml?and intraperitoneal instillation?20ml?of 0.5%ropivacaine.Anesthetic and surgical techniques were standardized.Numerical Rating Scale?NRS?of pain for the incisional,visceral,and shoulder pain during deep breath,the frequency of the patient pushing the button of the patient controlled analgesia?PCA?pump,fentanyl consumption,nausea or vomiting?PONV?or dizziness were collected for 24 hours postoperatively.Result:Patients in Group DEX and Group NS showed significantly less visceral pain at every time point and less incisional?shoulder pain at 12?24h postoperatively?P<0.05?.Group DEX showed significantly incisional and shoulder pain relief as compared to Group NS at 12?24h after surgery?P<0.05?;Total fentanyl consumption was significantly lower in Group DEX?236.44±42.77 ug?as compared to Group BK?19.80±49.81 ug?and NS?276.07±50.93 ug??P<0.05?.The frequency to push the button of the PCA were the highest in Group NS and the lowest in Group DEX?P<0.001?.There was no significant difference between groups with regard to adverse effects.Conclusion:The combined advance analgesia regimen of Intravenous dexamethasone and ropivacaine?peri-incisional and intraperitoneal?in Laparoscopic Cholecystectomy demonstrated that intravenous dexamethasone as an adjunct for Local Anesthetic prolongs the duration of analgesia effect and without additional side effects.