title: Epidural dexamethasone reduces the incidence of backache after lumbar epidural anesthesia.
abstract: We performed a prospective, randomized, double-blind study to compare the effect of epidural dexamethasone on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were randomly assigned to two groups: Group I patients received 25 mL 2% lidocaine with epinephrine 1:200,000 and 1 mL dexamethasone (5 mg) epidurally. Patients were interviewed at 24,48, and 72 h postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. A patient was considered to have postepidural backache when the postoperative VAS score was higher than the preoperative score. The incidence of postepidural backache in Group I patients for the 3 days were 22.8%, 17.4%, and 9.2%, all of which were significantly more frequent than observed in Group II patients (7.4%,5.6%, and 2.8%, P < 0.01). The severity and duration of postepidural backache were also significantly decreased in Group II patients. In our study, there was a significant association between postepidural backache and multiple attempts at epidural needle insertion. In summary, epidural dexamethasone reduced the incidence and severity of postepidural backache.
authors.affiliation: Department of Anaesthesia, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Y L
authors.initials: YL
authors.lastname: Wang
authors.forename: P P
authors.initials: PP
authors.lastname: Tan
authors.forename: C H
authors.initials: CH
authors.lastname: Yang
authors.forename: S C
authors.initials: SC
authors.lastname: Tsai
authors.forename: H S
authors.initials: HS
authors.lastname: Chung
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D007268:Injections, Epidural; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D008012:Lidocaine