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

BACKGROUND: Total laparoscopic hysterectomy (TLH) is quickly replacing the open abdominal hysterectomy, but is associated with unexpectedly high levels of pain. OBJECTIVES: The objective of this study was to compare the analgesic efficacy of adding dexamethasone to paracetamol and ketorolac (PaK) combination versus PaK combination in female patients undergoing elective TLH. MATERIALS AND METHODS: After approval from the institutional ethical committee, 100 American Society of Anesthesiologists I and II patients aged 18-60 years undergoing TLH under general anesthesia were included in this study. The patients were assigned to one of the two treatment groups (C and D). Patients in Group D received dexamethasone (0.2 mg/kg) intravenously (IV) dissolved in 100 ml of 0.9% saline 1 h before surgery and ketorolac 30 mg + paracetamol (PCM) 1 g IV prior to anesthesia being induced, while the patient in Group C received a placebo (100 ml of 0.9% normal saline) 1 h before surgery and ketorolac 30 mg + PCM 1 g IV before induction of anesthesia. RESULTS: Fentanyl consumption in the first 24 h was significantly higher in Group C (231.72 ± 84.07 μg) than in Group D (138 ± 48.7 μg) (P < 0.0001). Pain scores on the 0-100 Visual Analog Scale demonstrated notable variations at each point among the groups (P < 0.05). Postoperative nausea and vomiting scores differed at 15 and 30 min (P < 0.05). A transient rise in blood glucose occurred in Group D at 16 h (122 g/dl vs. 115 g/dl in Group C, P = 0.013). CONCLUSION: In patients undergoing TLH, a combination of dexamethasone, PCM, and ketorolac reduced 24-h opioid use, improved pain scores, and minimized immediate postoperative nausea and vomiting.