Local Wound Infiltration of Bupivacaine with Dexamethasone versus Bupivacaine Alone for Postoperative Pain after Total Abdominal Hysterectomy: A Randomized Controlled Trial
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Abstract
Objective: To assess the effectiveness of adding dexamethasone to bupivacaine for local wound infiltration in reducing postoperative pain post total abdominal hysterectomy (TAH) for benign gynecologic conditions.
Materials and Methods: A double-blind, randomized controlled trial enrolled women undergoing TAH for benign gynecologic conditions. All participants received local wound infiltration with 20 mL of 0.5% bupivacaine (100 mg). The intervention group additionally received 8 mg of dexamethasone, while the control group received normal saline. Postoperative pain was assessed using a 10-cm Visual Analogue Scale (VAS) at 2 (baseline), 6, 12, 18, and 24 hours postoperatively. Data were analyzed using a linear mixed model. A p-value < 0.05 was considered statistically significant.
Results: Fifty-two participants (26 per group) were enrolled between November 2024 and April 2025. Within-group analysis demonstrated a statistically significant reduction in VAS scores over time (p < 0.05). Between-group comparison showed significantly lower VAS scores at 12 hours postoperatively in the intervention group compared to the control group (4.3 ± 1.0 vs. 5.9 ± 1.3; mean difference, 1.6; 95% CI (0.33, 2.23); p = 0.009). There were no significant differences observed in total postoperative morphine consumption (12.7 ± 3.2 mg vs. 13.6 ± 3.1 mg; p = 0.313) or adverse events between the groups.
Conclusion: Addition dexamethasone to bupivacaine for local wound infiltration significantly decreased postoperative pain following TAH for benign gynecologic conditions, with a notable difference at 12 hours compared to bupivacaine alone. However, there was no clinical difference in postoperative morphine use.
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