Hamid Raza, Bashir Ahmed, Kamlaish.
Intrathecal Betamethasone; The Role Of Administrative Of Effective Post Operative Analgesic In Gynecologic Procedures, At A Tertiary Care Centre In Karachi, Pakistan.
Professional Med J Jan ;24(5):733-8.
Objectives: The aim of our study to determine the use of intrathecal betamethasone administration as effective post-operative analgesic in gynecologic procedures. Study Design: Randomized control trial. Period: 6 months duration from April 2015 to end of September 2015. Setting: Tertiary Care Centre in Karachi, Pakistan. Method: The study population consisted of n= 120 (divided into three groups using a random number generator) patients, who presented to our setup either via emergency or through the outpatient. The patients belonged to ASA class I and II, and underwent cesarean section. The group A was the control group, patients who received 0.5ml normal saline IV with bupivacaine 0.5% in 3ml, with 0.5ml of normal saline intrathecally. Group B consisted of patients who received 0.5ml IV normal saline, with 0.5% in 3ml bupivacaine along with 0.5ml betamethasone as 4mg per ml. The last group, group C consists of patients who received 0.5ml betamethasone IV (4ml/ml) along with 0.5% 3ml bupivacaine with 0.5ml of normal saline intrathecally. For the subjective measurement of pain level a visual analog scale was used. Various time intervals as time of initial first analgesic effect, time between intrathecal injection and first administration of diclofenac as rescue analgesic and the total number of analgesics used in the first twenty four hour period were also recorded in the proforma. Various side effects such as nausea, vomiting and headache were noted. Data was analyzed using SPSS version 23. Results: The study population consisted of n= 120 patients, divided into three groups using a random number generator, the demographic data like age, whether the procedure performed was elective or emergency etc did not show any difference p value of >0.05. The Visual analog scales scores at the 4 hour and 6 hour mark showed statistically significant difference, the values being lower in the medication groups versus the control group. But no difference was found between the control and medication groups in the VAS score measured at 12 hour and 24 hours respectively. The requirement for use of Diclofenac as rescue analgesia was also lower in the intrathecal and intravenous (group B and C) as compared to the control group at the 24 hour mark post operatively, and the dose required was even lower in the intrathecal group as compared to the intravenous group having a p value of 0.014. N= 27 patients suffered nausea and vomiting during the procedure, N= 40 patients reported headache following the 24 hour period post operatively. Conclusion: According to the results of our study intrathecal betamethasone administration is an effective method of post-operative pain reduction in cesarean section surgeries and it also decreases the need for rescue analgesia required.
PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com