RCT: Dexamethasone with ropivacaine in sciatic nerve block for foot surgery

Conventional Epidural (CE) and Dural Puncture Epidural (DPE) are prevalent analgesic methods in gynecological surgeries under general anesthesia. Utilizing the Nociception Level (NOL) index, which objectively measures intraoperative pain, facilitates the assessment of these techniques’ efficacy. This study aims to compare the effectiveness of CE and DPE analgesia, guided by the NOL index, in enhancing intraoperative and postoperative comfort in gynecological surgeries.

In this randomized study, 36 patients undergoing gynecological open surgeries were divided into two groups; one receiving CE and the other DPE for intraoperative analgesia. Both groups were administered 10 ml of 0.1% bupivacaine through the epidural catheter, with further doses adjusted based on the NOL index. Parameters such as total bupivacaine consumption, hemodynamic stability, use of vasoactive drugs, time with NOL ≥ 25 during surgery, post-anesthesia care unit discharge time, and postoperative adverse effects were recorded.

Comparative analysis showed no significant difference in total local anesthetic consumptions between groups (p> 0.05). Hemodynamic parameters, need for vasoactive agents do not differ in terms of groups (p> 0.05). There was also no difference in time to discharge from the post-anesthesia care unit , and postoperative side effects.

The study indicates no significant disparity in analgesic effectiveness between CE and DPE when guided by the NOL index, suggesting equivalent potential of both techniques in managing intraoperative pain in gynecological surgeries.