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Can Epidural Dexamethasone Reduce Patient-Controlled Epidural Consumption of Fentanyl and Levobupivacaine in Laboring Women? A Double-Blind, Randomized, Placebo-Controlled Trial

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Abstract

Background

The efficacy of a single bolus dose of epidural dexamethasone added to levobupivacaine–fentanyl combination for labor analgesia has not been studied. In this randomized double-blind controlled trial, we assessed the effect of epidural dexamethasone in reducing the hourly average consumption of epidural levobupivacaine–fentanyl combination in laboring parturients and to study its effect on pain score, maternal satisfaction, maternal and neonatal outcome.

Methods

Sixty adult ASA I-II single-gestation full-term primigravid laboring parturients with cervical dilation ≤ 5 cm were randomly assigned to two equal-sized groups. Combined spinal–epidural block was performed in all the parturients. After placing the epidural catheter in epidural space, 8 mg of preservative-free dexamethasone was administered to the dexamethasone group, and 0.9% saline to the placebo group. All parturients received continuous background infusion of 5 ml of 0.1% levobupivacaine with 2 μg/ml of fentanyl with the provision of patient-controlled bolus of 5 ml of 0.1% levobupivacaine with 2 μg/ml of fentanyl (lockout interval 15 min). The primary outcome measure was the hourly total consumption of levobupivacaine–fentanyl mixture. The secondary outcome measures were maternal satisfaction, pain score, maternal hemodynamic parameters, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores and adverse effects.

Results

Hourly drug consumption and hourly bolus requirement were significantly lower in the dexamethasone group than placebo group (6.97 ml ± 1.22 vs. 8.40 ml ± 2.59 and 0.41 ± 0.26 vs. 0.72 ± 0.55, respectively, P = 0.008 for both). There were no significant differences in other outcome measures.

Conclusion

Epidural dexamethasone significantly decreased average hourly drug consumption and the number of boluses in laboring parturients, thus providing epidural drug dose-sparing effect.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India

    Ankur Dhal, Sukanya Mitra, Richa Saroa & Jasveer Singh

  2. Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India

    Reeti Mehra

Authors
  1. Ankur Dhal
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  2. Sukanya Mitra
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  3. Richa Saroa
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  4. Jasveer Singh
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  5. Reeti Mehra
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Corresponding author

Correspondence to Sukanya Mitra.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Ankur Dhal completed his postgraduation (M.D.) in anesthesiology from Government Medical College and Hospital, Chandigarh, India. Sukanya Mitra is a Professor in Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Richa Saroa is Associate Professor, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Jasveer Singh is Associate Professor, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India. Reeti Mehra is Associate Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India.

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Dhal, A., Mitra, S., Saroa, R. et al. Can Epidural Dexamethasone Reduce Patient-Controlled Epidural Consumption of Fentanyl and Levobupivacaine in Laboring Women? A Double-Blind, Randomized, Placebo-Controlled Trial. J Obstet Gynecol India 69, 258–265 (2019). https://doi.org/10.1007/s13224-018-1189-2

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  • DOI: https://doi.org/10.1007/s13224-018-1189-2

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