Impact of intra-operative dexamethasone after scheduled Cesarean Delivery

Summary by Harrison Ghouche DO, 10.24.22
https://pubmed.ncbi.nlm.nih.gov/31345664/#:~:text=Conclusions%3A%20This%20impact%20study%20involving,a%20multimodal%20postoperative%20analgesic%20regimen.

Take Home Point:

• Take Home Point:

  • A single dose of intra-operative IV dexamethasone 4 mg after scheduled cesarean delivery (CD) with spinal or CSE anesthesia did not decrease;

    • Time to first opioid administration after CD

    • Opioid consumption

    • Pain scores or the incidence and treatment of any side effect (including PONV and pruritus)

  • *When used in combination with a multimodal analgesic strategy including intrathecal morphine, NSAIDs, acetaminophen, and oral opioids for breakthrough pain*

    • Important to make sure your patient is on an appropriate multimodal regimen

  • Dexamethasone may be of benefit for women not receiving neuraxial morphine or NSAIDs, or for those at high risk of postoperative pain or PONV.

Summary:

Background:

This study aimed to evaluate if routine intra-operative administration of dexamethasone improved analgesia and decreased postoperative nausea and vomiting after scheduled cesarean delivery.

Methods:

Retrospective impact study, 187 patients undergoing cesarean delivery with spinal or epidural anesthesia received 4mg dexamethasone intravenously intraoperatively, and 182 did not. 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 were no differences in median opioid consumption (in IV morphine equivalents) in the first 48 h postoperatively (7.5 [0.0–22.5] vs 10.0 [2.5–25.0] mg in those not receiving and receiving dexamethasone respectively, P=0.17) or in any other postoperative time epoch except for >24–36 h. The incidence and treatment of PONV were similar between groups, as was the administration of metoclopramide intra-operatively. There were no differences in overall satisfaction (96.1% ± 13.1 in those not receiving dexamethasone vs 98.1% ± 6.0 in women receiving dexamethasone, P=0.54)

Conclusion:

This study found that the use of 4mg IV intraoperative dexamethasone provided no additional pain or PONV benefits for patients undergoing a cesarean delivery under neuraxial anesthesia when an appropriate multimodal analgesia regimen is in place.