A Comparison of Safety and Effectiveness of Epidural Morphine Versus Epidural Morphine with Dexamethasone for Post Operative Analgesia in Infraumbilical Surgeries

Epidural morphine provides effective pain relief and patient satisfaction following major surgeries. It acts by binding to opioid receptors in the spinal cord, thereby reducing transmission of pain signals.  However adverse effects of opioids such as pruritis, nausea, vomiting, urinary retention are non-fatal but troublesome whereas delayed respiratory depression especially with higher doses of epidural morphine (>2 mg) can be a serious side effect. Dexamethasone is a long-acting corticosteroid improves quality of sensory block in peripheral nerve blocks and epidural anaesthesia. The mechanism of action is by decreasing inflammation, delaying impulses in C-fibers, and stopping the ectopic discharges of the nerves, thus enhances the duration of analgesia with opioid sparing and antiemetic effects. This study has been designed to evaluate the usefulness of 1mg morphine versus combination of 0.5mg morphine and 4mgdexamethasone in providing postoperative analgesia with respect to duration and quality of analgesia.