Efficacy of Adding Dexamethasone to Levobupivacaine in Erector Spinae Block for Total Hip Arthroplasty

Abstract

Background: Dexamethasone, when supplemented to a nerve block, promotes its performance while diminishing opioid demands. Objective: This study was designed to identify the analgesic efficacy of combining dexamethasone with levobupivacaine in the erector spinae block (ESB) for total hip arthroplasty (THA) utilizing ultrasound guidance. Patients and Methods: 82 patients of both sexes, with ASA physical status I-II, aged from 40 to 70 years were scheduled for a unilateral ESB before general anaesthesia for total hip arthroplasty. They were randomly assigned to two equal groups (n=41each): Levo group: unilateral ESP block was done using 20 mL of 0.5% levobupivacaine only. Dexa group: unilateral ESP block using 19 mL 0.5% levobupivacaine and 1 ml dexamethasone. Preoperative pain was assessed by visual analogue scale (VAS) as well as particular hemodynamics preoperatively and at 0, 2, 4, 8, 12, 16 and 24 hours post-operatively. The total dose of pethidine (mg) given in the first 24-hour was recorded in both groups as the initial analgesic necessity. A list of postoperative complications was kept. Result: Patients in dexa group demonstrated prolonged postoperative analgesia compared to those in levo group. In the first 24 hours, dexa group had a significantly lower postoperative VAS score, lower cumulative pethidine doses and longer duration until the first request for analgesia than levo group. The two groups had statistically negligible differences in hemodynamic alterations and the incidence of side effects. Conclusions: Using dexamethasone as an adjuvant of ESB with Levobupivacaine, provided effective postoperative analgesia through reducing pain VAS score without any reported hemodynamics or postoperative complications.