Comparison of the opioid-sparing effects of a combination of dexamethasone, paracetamol, and ketorolac versus paracetamol and ketorolac in patients undergoing total laparoscopic hysterectomy: A prospective double-blind randomized controlled trial.
Isha Nene, Parin Lalwani, Puneet Khanna et al.
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In 30 seconds
This prospective, double-blind randomized controlled trial compared adding intravenous dexamethasone to paracetamol and ketorolac with paracetamol and ketorolac alone in 100 women aged 18–60 years with ASA I–II status undergoing elective total laparoscopic hysterectomy. Fentanyl use during the first 24 hours was lower with dexamethasone: 138 ± 48.7 μg versus 231.72 ± 84.07 μg in the control group (P < 0.0001). The dexamethasone group also had better pain scores and less immediate postoperative nausea and vomiting, alongside a transient rise in blood glucose.
Key findings
- First-24-hour fentanyl consumption was 138 ± 48.7 μg with dexamethasone versus 231.72 ± 84.07 μg with placebo (P < 0.0001).
- Pain scores differed between groups at each assessment point (P < 0.05), favoring the dexamethasone combination.
- Postoperative nausea and vomiting scores differed at 15 and 30 min (P < 0.05).
- At 16 h, blood glucose was 122 g/dl in the dexamethasone group versus 115 g/dl in controls (P = 0.013); the rise was described as transient.
Why it matters
The trial suggests that adding dexamethasone to a paracetamol–ketorolac regimen can reduce early opioid requirements after total laparoscopic hysterectomy, while also improving reported pain and immediate nausea and vomiting outcomes. The observed transient glucose increase is relevant when weighing this multimodal approach. These findings inform perioperative analgesia but apply to the studied elective surgical population.
What to keep in mind
The study included only 100 ASA I–II patients aged 18–60 years undergoing elective total laparoscopic hysterectomy; the abstract reports outcomes only through the early postoperative period.