Comparative Analysis of Epidural Dexamethasone and Epidural Morphine (EM) for Postoperative Pain Control After Total Abdominal Hysterectomy: A Randomized Clinical Trial

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AuthorDivyalakshmi Ten
AuthorShanu Shanmugasundaramen
AuthorPriyanka Cen
AuthorBrindha Sken
AuthorArbind Kumar Choudharyen
AuthorPanneerselvam Periaswamyen
OrcidDivyalakshmi T [0009-0005-4461-5968]en
OrcidShanu Shanmugasundaram [0000-0002-1336-6381]en
OrcidPriyanka C [0009-0009-1296-9357]en
OrcidBrindha Sk [0000-0002-9776-2700]en
OrcidArbind Kumar Choudhary [0000-0001-8910-1745]en
OrcidPanneerselvam Periaswamy [0000-0002-3358-313X]en
Issued Date2024-09-30en
AbstractBackground: Epidural anesthesia is commonly utilized for pain management following lower abdominal surgeries; however, the search for an optimal analgesic additive continues. Objectives: This study aimed to compare the efficacy of epidural dexamethasone versus epidural morphine (EM) in managing postoperative pain after total abdominal hysterectomy. Methods: This randomized controlled trial enrolled patients undergoing total abdominal hysterectomy (TBAH) and assigned them to two groups: Group D (Dexamethasone), which received epidural dexamethasone (8 mg) with bupivacaine, and Group M (Morphine), which received epidural morphine (10 mg) with bupivacaine. Marcaine (bupivacaine) 0.25% was used in both groups. Baseline characteristics, surgical outcomes, physiological parameters, pain management, adverse effects, and blood sugar levels were analyzed and compared between the groups. Results: The groups exhibited similar initial characteristics and surgical outcomes. Vital signs, including heart rate (HR), mean arterial pressure, respiratory rate, and oxygen saturation, remained consistent before and after surgery. The Dexamethasone group (Group D) demonstrated superior pain control compared to the Morphine group (Group M). Patients in Group D required pain medication for a significantly shorter duration (24 hours vs. 36 hours, P < 0.05), representing a 50% reduction in medication duration. Additionally, Group D patients required fewer rescue analgesics (1.2 doses vs. 2.1 doses, P < 0.05), indicating a 43% decrease in the need for additional medication. The time to a visual analog scale (VAS) score exceeding 4 was significantly longer in Group D, indicating less intense pain for an extended period. Although no significant differences were observed in common postoperative side effects, Group D exhibited a lower incidence of these effects, albeit not statistically significant. Furthermore, Group D showed a significantly lower incidence of hyperglycemia at the 8th hour post-surgery compared to Group M (P < 0.05), suggesting a potential benefit of epidural dexamethasone in mitigating hyperglycemia risk. Conclusions: Epidural dexamethasone appears to offer superior analgesic efficacy compared to epidural morphine in postoperative pain management after total abdominal hysterectomy. The findings suggest that Group D (Dexamethasone) experienced improved pain management, reduced medication requirements, and a lower incidence of hyperglycemia. Further research with larger cohorts and extended follow-up is warranted to validate these findings and guide clinical practice.en
DOIhttps://doi.org/10.5812/jcma-146995en
URIhttps://brieflands.com/journals/jcma/articles/146995en
KeywordAnesthesia Epiduralen
KeywordBupivacaineen
KeywordDexamethasoneen
KeywordMorphineen
KeywordPain Postoperativeen
KeywordTotal Abdominal Hysterectomyen
PublisherBrieflandsen
TitleComparative Analysis of Epidural Dexamethasone and Epidural Morphine (EM) for Postoperative Pain Control After Total Abdominal Hysterectomy: A Randomized Clinical Trialen
TypeResearch Articleen

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