Background: General anesthesia is the typical anesthetic technique for laparoscopic intervention, however, the use of regional anesthesia in the laparoscopic field started to gain familiarity. Shoulder tip pain is a major intraoperative concern that may hinder the feasibility of laparoscopic interventions under spinal anesthesia.

Aim of the study: To evaluate the effect of the intrathecal addition of dexamethasone versus fentanyl on the severity of intraoperative shoulder tip pain during gynecologic laparoscopic surgeries.

 Methods: This RCT included 120 patients, randomized into three equal groups (Group D: received 15 mg bupivacaine and 8 mg dexamethasone intrathecally, Group F: received 15 mg bupivacaine and 25 µg fentanyle intrathecally and Group C: received 15 mg bupivacaine and normal saline intrathecally.

 Results: Significantly fewer patients experienced intraoperative shoulder tip pain in Groups F (n=17) and D (n=19) compared with Group C (n=30), P < 0.005, with no statistical difference detected between Groups D and C. Only two patients in both Groups D and F experienced moderate pain intensity versus eight patients in Group C, P = 0.011. The incidence of postspinal shivering was lower in Groups D and F in comparison to Group C; P = 0.002.

Conclusion:

The use of dexamethasone or fentanyle intrathecally may reduce the incidence and severity of shoulder tip pain during laparoscopic ovarian cystectomy under spinal anesthesia.

Keywords: Dexamethasone, Laparoscopy, Fentanyl, Shoulder Tip Pain, Spinal Anesthesia.