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The Effect of a Single Dose of Intravenous Dexamethasone on Nausea and Vomiting when Administered Prior to Intrathecal Morphine for Cesarean Section: a Randomized, Placebo-controlled, Double-blinded Trial
Abstract Number: T-03
Abstract Type: Original Research
Background: The incidence of intraoperative and postoperative nausea and vomiting (IONV & PONV) during Cesarean section under spinal anesthesia is estimated to be 30-60%. Prophylaxis of PONV, therefore, is an area of great interest to the obstetric anesthesiologist. Administration of dexamethasone as a prophylactic agent has been investigated secondary to its effective use in the context of general anesthesia. Multiple studies have confirmed a significant reduction in PONV in patients that received dexamethasone prior to epidural Duramorph. Three randomized control trials (RCTs) have investigated the use of dexamethasone for PONV prophylaxis during spinal anesthesia. Two showed no effect when given after Duramorph, one showed a significant reduction when given prior. This study is the largest RCT of its type and an attempt to replicate the positive finding.
Methods: A double-blinded, randomized, placebo-controlled trial was conducted between November, 2012 and September, 2014. 108 pregnant women scheduled for cesarean section were randomized into two groups: group A received 8 mg of dexamethasone, group B received placebo. Both groups then received spinal anesthesia with 200mcg of Duramorph. Patients were seen upon arrival to the post-operative care unit (PACU) and at 1, 3, 6, 24 and 48 hours following PACU arrival. At these time points, the patients’ report of nausea and vomiting, pain and overall satisfaction were recorded. Vital signs, rescue anti-emetics and analgesics were extracted from the electronic medical record. Chi-square tests, two sample t-tests and non-parametric Mann-Whitney U tests were performed, as appropriate. All P values were two-sided with significance evaluated at the 0.05 alpha level. All analyses were executed in Stata IC, Version 13 (College Station, TX, USA).
Results: The treatment group receiving dexamethasone prior to Cesarean section (N=55) did not significantly differ from the control group (N=53) in whether or not they experienced an emesis episode at any time up to 48 hours after surgery, p=0.34, Chi square=0.93. Likewise, there was no significant difference in the total dose of rescue antiemetics administered throughout the 48 hour period (treatment mean=2.26, 95% CI=1.47-3.06; control mean=3.27, 95% CI=2.32-4.23).
Conclusions: Administration of 8 mg of intravenous dexamethasone prior to spinal anesthesia with Duramorph was not associated with a decrease in PONV. Likewise, dexamethasone was not superior to placebo in overall use of antiemetics or analgesics. There is some evidence to suggest that a single dose of antenatal glucocorticoids has an effect on neonatal hypothalamic-pituitary axis function, although no evidence demonstrating harm to the mother or fetus. However, given that this rigorously designed and analyzed study did not identify any benefit associated with the use of dexamethasone, it may be prudent to avoid administering the medication prior to delivery.