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

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.