The effect of a single intraoperative dose of intravenous dexamethasone 8 mg on post-cesarean delivery analgesia: a randomized controlled trial

Background: A single perioperative dose of dexamethasone has been shown to improve postoperative analgesia and reduce opioid consumption. However, this analgesic and opioid sparing effect has not been well assessed as part of a multimodal analgesic regimen in women post-cesarean delivery. Methods: Healthy women having cesarean delivery under spinal anesthesia were randomly assigned to receive intravenous dexamethasone 8 mg or placebo after delivery and clamping of the umbilical cord. The primary outcome variable was total opioid consumption in the 24 hours following cesarean delivery. We hypothesized that a single dose of intravenous dexamethasone, administered as part of a multimodal analgesia regimen after spinal anesthesia for cesarean delivery, would significantly reduce postoperative opioid consumption. Results: Fifty-two women were enrolled and randomized to two groups of 26 patients. The median (IQR) opioid consumption in the first 24 hours after cesarean delivery was 12 mg (5-20 mg) in the dexamethasone group compared to 15 mg (5-22 mg) in the placebo group. The median difference in opioid consumption at 24 hours (95% CI) was -3 mg (-12.2 to 5.7) and was not significantly different between groups (P=0.32). Conclusions: The addition of intravenous dexamethasone 8 mg to a multimodal postoperative analgesic regimen that included intrathecal morphine, in women who had a cesarean delivery under spinal anesthesia, did not reduce 24 hour postoperative opioid consumption. (C) 2018 Elsevier Ltd. All rights reserved.