Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

Abstract

Background: Pain after laparoscopic bariatric surgeries has negative effects on patients' recovery. Objective: To evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative pain relief after laparoscopic bariatric surgeries. Patients and Methods: Sixty patients were randomly allocated into 3 groups as follows: Group B (n=20): bupivacaine 100 ml 0.25% + 5 ml normal saline. Group BD4 (n=20): bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) + saline 4 ml, and Group BD8: (n=20) bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml. Postoperatively ketorolac IV 30 mg/6 hours + Paracetamol IV 1 g/8 hours were given± nalbuphine. Results: Pain was lower in Group BD8. Sedation was deeper in Group B. Time to first supplementary analgesia was longer in Group BD8 than Groups B or BD4, and longer in Group BD4 compared to Group B. Patients requiring supplementary analgesia were less in Group BD8 than Groups B or BD4. Total postoperative consumption of nalbuphine in the first postoperative day (POD 1) was less in Group BD8 than Groups B or BD4, and less in Group BD4 than Group B. Time for independent ambulation was shorter in Group BD8 than Groups B or BD4, and shorter in Group BD4 than Group B. Postoperative nausea and vomiting (PONV) was higher in Group B compared to other groups. Conclusion: Intraperitoneal administration of either 4 mg or 8 mg dexamethasone to bupivacaine (0.25%) resulted in better recovery and pain relief after bariatric surgeries. Dexamethasone 8 mg is superior to 4 mg.