Postoperative back pain following epidural anesthesia: Can dexamethasone help?

Masoud Saghafinia, Nahid Nafissi, Mohammad Hosein Kalantar Motamedi, Reza Asadollahi


Epidural anesthesia (EA) is a central neuraxial block with many applications. Improvements in equipment, drugs and
techniques have made it a popular and versatile anesthetic procedure. However, back pain is a common postoperative
complaint. We aimed to determine the effect of dexamethasone added to EA to reduce post-epidural anesthesia backache.
Fifty-nine patients scheduled undergoing surgery were randomly assigned to two groups: Case group (30 patients)
received 300 mg lidocaine (1.5%) plus 1/200,000 epinephrine and 4 mg dexamethasone (1CC) for epidural anesthesia,
and a control group (29 patients) received 300 mg lidocaine (1.5%) with 1/200000 epinephrine and 1CC normal
saline (placebo). Patients were visited 12, 24 and 48 hours after operation, and the severity of post-epidural backache
was recorded according to a visual analogue scale pain score. In the case group, 29 patients (96.6%) had mild back
pain, and only 1 patient (3.3%) had moderate back pain and none experienced severe back pain post-operatively. In the
control group, 19 patients (65.5%) had mild backache, 9 patients experienced moderate and 1 had severe backache.
Mean backache severity score of the case group was statistically lower than the control group (P = 0.003), after 12 h
(P = 0.001), 24 h (P = 0.00) and 48 h (P = 0.002) postoperatively. Dexamethasone addition may be effective in reducing severe to moderate post-epidural anesthesia backache in EA patients.
Key words: Dexamethasone, epidural anesthesia, post-epidural backache

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