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 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 study 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. Group C: received 15 mg bupivacaine and normal saline intrathecally.

 Results: Significantly fewer patients experienced intraoperative shoulder pain in Group F (17) and Group D (19)  than Group C (30); P = 0.006,  with no statistical difference detected between Group D and C. Only two patients in both Groups D and F experienced moderate pain intensity versus 8 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:

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

Keywords:dexamethasone, laparoscopy, fentanyl, shoulder pain, spinal anesthesia.