Incorporating dexamethasone with heavy bupivacaine in unilateral spinal anesthesia for lower limb Open Reduction and Internal Fixation

Submitted: January 1, 2024
Accepted: May 3, 2024
Published: June 28, 2024
Abstract Views: 23
PDF: 8
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


The use of additives in regional anesthesia, regardless of the local anesthetic agent used, the type of surgery, or the method of pain assessment, provides superior analgesia to parenteral opioids and, when used appropriately, reduces both opioid consumption and opioid-related adverse effects in the immediate postoperative period and therefore better recovery profile and patient satisfaction. Therefore, this study aimed at determining and comparing analgesic consumption between the use of 10 mg of 0.5% hyperbaric bupivacaine alone and in combination with dexamethasone for unilateral spinal anesthesia for lower limb Open Reduction and Internal Fixation (ORIF). This was a prospective double-blinded randomized study. It involved 68 consented American Society of Anesthesiologists (ASA) I and II patients, aged 18-75 years, scheduled for unilateral lower limb ORIF. Ethical approval was obtained, NHREC/25/10/2013. Patients were randomly allocated accordingly. Monitoring of hemodynamic parameters was done during the perioperative period. Visual Analogue Scale (VAS) and Bromage scores were regularly assessed, and rescue analgesia was utilized in patients with VAS greater than or equal to 4. The data obtained were analyzed using the Statistical Package for Social Sciences (SPSS; Armonk, USA). Student T-test was used to compare the quantitative variables, while Chi-squared (X2) test was used to compare the qualitative variables. Results were presented in tables and figures, and p<0.05 was regarded as statistically significant. The mean age of the patients in groups BA and BD were 39.97±11.22 and 39.12±12.37 years, respectively, and was not statistically significant, p=0.77. The male-to-female ratio for groups BA and BD was 19:15 and 21:13, respectively, p=0.64. The mean VAS score in the first two hours was not significant. However, in the third hour, the mean VAS was 2.97±1.00 and 0.18±0.56 (p=0.001); in the fourth hour, it was 2.85±1.58 and 0.94±1.34 (p=0.001), and the eighth hour was 1.79±0.41 and 3.82±1.49 (p=0.001) which were statistically significant. The mean total analgesic consumption was 226.66±45.52 and 148.79±40.58 in groups BA and BD, respectively, which was statistically significant (p=0.000) This study revealed that the addition of 4 mg dexamethasone to 10 mg of 0.5% heavy bupivacaine intrathecally was associated with less opioid consumption compared with the use of 0.5% heavy bupivacaine alone in unilateral spinal anesthesia for unilateral ORIF.



PlumX Metrics


Download data is not yet available.


Krishna PGV, Khanna S, Jaishree SV. Review of adjuvants to local anesthetics in peripheral nerve blocks: current and future trends. Saudi Journal of Anaesthesia 2020;14:77-84.
Unal D, Ozdogan L, Ornek HD, et al. Selective spinal anaesthesia with low dose bupivacaine and bupivacaine plus fentanyl in ambulatory arthroscopic knee surgery. J Pak Med Assoc 2012;62:313-8.
Kim WH, Ko JS, Ahn HJ, et al. Epinephrine decreases the dose of hyperbaric bupivacaine necessary for tourniquet pain blockade during spinal anaesthesia for total knee replacement arthroplasty. J Anesth 2013;27:72-9.
Van Tuijl I, Giezeman MJ, Braithwaite SA, et al. Intrathecal low- dose hyperbaric bupivacaine-clonidine combination in outpatient knee arthroscopy. Acta Anaesthesiol Scand 2008;52:343-9.
Ishaque M, Siddiqi R, Hashmi SN, et al. A study of postoperative analgesia and adverse effects produced by intrathecal neostigmine, morphine and their combination in patients undergoing elective Cesarean section under spinal anaesthesia. Pak Armed Forces Med J 2005;55:116-21.
Ahmad MAE, Ashraf AM, Sahar AM, Mohamed AMM. Effect of intrathecally administered ketamine, morphine, and their combination added to bupivacaine in patients undergoing major abdominal cancer surgery: a randomized, double-blind study. Pain Medicine 2018;19:561-8.
Sharma A, Varghese N, Venkateswaran R. Effect of intrathecal dexmedetomidine versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine. Journal of Anaesthesiology Clinical Pharmacology 2020;36:381-5.
Bhavna G. Role of Dexamethasone in peri-operative anaesthesia management: a review of the literature. Anesthesiol Open J 2017;2:33-9.
Büttner B, Mansur A, Bauer M, Hinz J, Bergmann I. Unilateral spinal anaesthesia: literature review and recommendations. Anaesthetist 2016;65:847-65.
Tomar GS, Ganguly S, Cherian G. Effect of perineural dexamethasone with bupivacaine in single space paravertebral block for postoperative analgesia in elective nephrectomy cases: a double-blind placebo-controlled trial. Am J Ther 2017;24:713-7.
Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: a prospective randomized controlled trial. Saudi J Anaesth 2012;6:229-33.
Cummings KC, Napierkowaski DE, Sanchez IP, et al. Effects of dexamethasone on duration of interscalene nerve block with ropivacaine or bupivacaine. Br J Anesth 2011;107:438-45.
Bousabbeh A, Ketata S, Sahnoun N, et al. The effect of dexamethasone as an adjuvant in spinal anesthesia for femur upper extremity surgery: a prospective randomized trial. Pan Afr Med J 2022;43:29.
Deo SP, Ahmad MS, Singh A. effectiveness of dexamethasone or adrenaline with lignocaine 2% for prolonging inferior alveolar nerve block: a randomized controlled trial. J Korean Assoc Oral Maxillofac Surg 2022;48:21-32.
Johansson A, Hao J, Sjölund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand 1990;34:335-8.
Hassan AA, Al-Kumity AA, Ahmed MS, Shabaiek IA. Clinical comparative study between intrathecal dexmedetomidine and dexamethasone on prolonging the duration of intrathecal blockade in lower limb orthopaedic surgery. Al-Azhar Med J 2021;50:1467-78.
Kayalha H, Ahmadi GS, Parsa H, Beingom KM. The analgesic efficacy of low dose dexamethasone added to bupivacaine in ilioinguinal and iliohypogastric nerve block in patients undergoing inguinal hernia surgery under spinal anaesthesia. J Med Biomed Res 2019;27:16-22.

How to Cite

Ibrahim, N., Panda, S. U., Bawa, I. A., Ballah, A. M., Kalakwa, M. A., Abdullahi, I. S., … Adamu, S. A. (2024). Incorporating dexamethasone with heavy bupivacaine in unilateral spinal anesthesia for lower limb Open Reduction and Internal Fixation. Annals of African Medical Research, 7(1).