Impact of intra-operative dexamethasone after scheduled cesarean delivery: a retrospective study.

Abstract

BACKGROUND: Dexamethasone is an effective analgesic and anti-emetic in patients undergoing many surgical procedures but its effects on pain after cesarean delivery are poorly studied. The aim of this study was to evaluate if routine intra-operative administration of dexamethasone improved analgesia and decreased postoperative nausea and vomiting after scheduled cesarean delivery.METHODS: Electronic medical record data for scheduled cesarean deliveries performed under neuraxial anesthesia, before and after a practice change that introduced the routine use of intravenous dexamethasone 4?mg, were obtained. Patients were analyzed based on whether they received routine care (n=182) or also received dexamethasone (n=187). The primary outcome was time to first opioid use. Secondary outcomes included postoperative opioid consumption, pain scores, incidence and treatment of postoperative nausea and vomiting, satisfaction and length of stay.RESULTS: There was no significant difference between groups in median time to first postoperative opioid administration (15.8 [3.4-48.0] h routine care vs 14.7 [3.2-38.8] h routine care plus dexamethasone, P=0.08). There were no significant differences in any secondary outcomes.CONCLUSIONS: This impact study involving more than 360 patients suggests that routine administration of intra-operative intravenous dexamethasone 4?mg does not provide additional analgesic benefit after scheduled cesarean delivery, in the context of a multimodal postoperative analgesic regimen. Studies are required to determine if a larger dose or repeated administration influence postoperative analgesia or side effects, or whether certain subsets of patients may benefit.

View details for DOI 10.1016/j.ijoa.2019.06.006

View details for PubMedID 31345664