الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Aim of the work:
The aim of our study was to evaluate the effect of preoperative administration of epidural dexamethasone with or without bupivacaine on postoperative pain relief and morphine consumption in patients undergoing laparoscopic cholecystectomy.
Summary and Conclusion
The study was carried out in El Minia University Hospital during the period from October 2007 to July 2008. The study involved sixty patients of either sex, ASA physical status I-II scheduled for elective laparoscopic cholecyctectomy.
The aim of our study was to evaluate the efficacy of preoperative epidural injection of dexamethasone (5mg) with or without bupivacaine in postoperative pain relief and reduce morphine consumption in patients undergoing laparoscopic cholecystectomy
Patients were randomly allocated into three equal groups (20 patients each).
Group I (Bupivacaine group, B) patients received Dexamethasone (5mg) in normal saline 2 mL IV with epidural injection of bupivacaine 0.25% 10mL and normal saline 2 mL.
Group 2 (Bupivacaine-dexamethasone group, BD) patients received normal saline 2 mL IV with epidural injection of bupivacaine 0.25% 10 mL and dexamethasone (5 mg) in normal saline 2 mL.
Group 3 (dexamethasone group, D) patients received normal saline 2 mL IV with epidural injection of dexamethasone (5 mg) in normal saline 12 mL.
Study parameters including VAS pain score at rest and with effort, time to first analgesic request, total amount of morphine administrated, hemodynamics variables (blood pressure, pulse), oxygen saturation and any adverse events were recorded. Postoperatively 2- 4 mg morphine IV was given as a rescue analgesic when VAS pain score ≥ 3.
Our study demonstrated that the preoperative administration of epidural dexamethasone with or without bupivacaine produced a statistically significant reduction in postoperative pain score at rest and with effort in comparisone with bupivacaine group.
The time to first analgesic request was significantly longer in patients who received epidural bupivacaine-dexamethasone (9.7 ± 2.2 hr), epidural dexamethasone (7.8 ± 2.9 hr) as compared with the bupivacaine group (4.5 ±1.5 hr).
Morphine consumption during the first 24 hrs following laparoscopic cholecystectomy was significantly lower in group II and group III in comparisone with group I.
No differences in the hemodynamic variables between the groups and there was no significant adverse effects in our study.
We can conclude that the preoperative epidural injection of dexamethasone 5 mg with or without bupivacaine provide postoperative pain relief and reduce morphine consumption without side effects in patients undergoing laparoscopic cholecystectomy.