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Dexamethasone as analgesic adjunct for post-cesarean delivery
Abstract Number: SAT-07
Abstract Type: Original Research
Introduction: Poorly controlled pain after cesarean delivery (CD) can be a significant source of morbidity including an increased risk of venous thromboembolism, chronic pain, and depression. Dexamethasone (DEX), a commonly administered antiemetic, might have analgesic properties for general surgical patients. However, analgesic effects of DEX in women undergoing CD under spinal anesthesia remains unclear. We hypothesized that a single perioperative dose of DEX 8 mg would significantly reduce postoperative opioid consumption at 24-h in women who underwent CD under spinal anesthesia.
Methods: ASA 1-3 women scheduled to undergo CD were randomized to receive either IV DEX 8mg or placebo after administration of spinal anesthesia (hyperbaric bupivacaine 12 mg, morphine 150 mcg and fentanyl 15 mcg) but prior to skin incision. Randomization was stratified by presence or absence of mechanical temporal summation. Postoperatively, all patients received scheduled acetaminophen and naproxen in combination with PRN oxycodone and IV morphine. All postoperative opioids were converted to IV morphine equivalents. The primary outcome was opioid consumption at 24-h. Secondary outcomes included time to first analgesic request, opioid consumption at 48-h, pain scores at rest and on movement at 2, 24 and 48-h, need for rescue antiemetics, and incidence and severity of nausea and vomiting. Wilcoxon rank sum and chi-square tests were used as appropriate. Log-rank test was used to test the Kaplan-Meier survival curves between groups for time to first analgesic request. Multivariable regression models were used to test the treatment effect with covariate adjustment.
Results: There were no differences in patient characteristics and preoperative risk factors for nausea and vomiting between the 2 groups. The results are summarized in the table. In univariate analysis, there were no differences in opioid consumption, pain scores, or time to first analgesic request between the groups. When controlled for covariates, DEX reduced 24-h pain scores at rest (parameter estimate=-1.213, p=0.032). DEX also reduced vomiting episodes and need for postoperative antiemetics at 2-h.
Conclusion: Administration of DEX does not appear to reduce opioid consumption, but it may be associated with a modest reduction in postoperative pain scores and nausea and vomiting. A single dose of DEX may not be a useful analgesic adjunct in a multimodal postoperative analgesia regime after CD.