Journal of Research in Pharmacy Practice

The effect of intravenous Dexamethasone on post‑cesarean section pain and vital signs: A double‑blind randomized clinical trial

Document Type : Original Article

Authors

. Azar Danesh Shahraki 1
. Awat Feizi 2
. Mitra Jabalameli 3
. Shadi Nouri 4

1 Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran

4 School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract
Objective: Any operation leads to body stress and tissue injury that causes pain and 
its complications. Glucocorticoids such as Dexamethasone are strong anti‑inflammatory 
agents, which can be used for a short time post‑operative pain control in various surgeries. 
Main purpose of this study is to evaluate the effect of administration of intravenous (IV) 
Dexamethasone on reducing the pain after cesarean.
Methods: A double‑blind prospective randomized clinical trial was performed on 60 
patients candidate for elective caesarean section. Patients were randomly assigned into 
two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). 
In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), 
respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were 
recorded in different time points during first 24 h after operation. Statistical methods 
using repeated measure analysis of variances and t‑test, Mann‑Whitney and Chi‑square 
tests were used for analyzing data.
Findings: The results indicated that within‑group comparisons including severity of pain, 
MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study 
period. Between group comparisons indicated significant differences in terms of pain 
severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in 
case group were lower than the control group.
Conclusion: IV Dexamethasone could efficiently reduce post‑operative pain severity and 
the need for analgesic consumption and improve vital signs after cesarean section.

Keywords

Cesarean
Dexamethasone
pain
vital signs
  1. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet 
    2011;377:2215‑25.
    2. Liu K, Hsu CC, Chia YY. Effect of dexamethasone on 
    postoperative emesis and pain. Br J Anaesth 1998;80:85‑6.
    3. Jokela RM, Ahonen JV, Tallgren MK, Marjakangas PC, 
    Korttila KT. The effective analgesic dose of dexamethasone 
    after laparoscopic hysterectomy. Anesth Analg 
    2009;109:607‑15.
    4. Kardash K, Sarrazin F, Tressler M, Velly A. Single dose 
    dexamethasone reduces dynamic pain after total hip 
    artroplasty. Pain Med 2008;4:1253‑7.
    5. Wu JI, LoY, ChiaYY, Liu K, FongWP, Yang LC, et al. Prevention 
    of postoperative nausea and vomiting after intrathecal 
    morphine for cesarean section: A randomized comparison of 
    dexamethasone, droperidol, and a combination. Int J Obstet 
    Anesth 2007;16:122‑7.
    6. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, 
    Akbarian‑Tefaghi N. The effect of intravenous administration 
    of dexamethasone on postoperative pain, nausea, and 
    vomiting after intrathecal injection of meperidine. Anesth 
    Analg 2007;104:987‑9.
    7. Aminmansour B, Khalili HA, Ahmadi J, Nourian M. Effect 
    of high‑dose intravenous dexamethasone on postlumbar 
    discectomy pain. Spine (Phila Pa 1976) 2006;31:2415‑7.
    8. Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of 
    preoperative dexamethasone on early oral intake, vomiting 
    and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 
    2006;70:73‑9.
    9. El Azab SR, Rosseel PM, de Lange JJ, Groeneveld AB, 
    van Strik R, van Wijk EM, et al. Dexamethasone decreases 
    the pro‑ to anti‑inflammatory cytokine ratio during cardiac 
    surgery. Br J Anaesth 2002;88:496‑501.
    10. ShahrakiAD, Jabalameli M, Ghaedi S. Pain relief after cesarean 
    section: Oral methadone vs. intramuscular pethidine. J Res 
    Med Sci 2012;17:143‑7.
    11. Jabalameli M, Saryazdi H, Massahipour O. The effect of 
    subcutaneous dexamethasone added to bupivacaine on 
    postcesarean pain: A randomized controlled trial. JIMS 
    2010;35:21‑6.
    12. Jaafarpour M, Khani A, Dyrekvandmoghadam A, 
    Khajavikhan J, Saaidpour Kh. The effect of dexamethasone 
    on nausea, vomiting and pain in parturients undergoing 
    caesarean delivery. J Clin Diagn Res 2008;3:854‑8.
    13. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative 
    nausea and vomiting after spinal morphine for caesarean 
    section: Comparison of cyclizine, dexamethasone and placebo. 
    Br J Anaesth 2003;90:665‑70.
    14. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, 
    Kirmeyer S. Births: Final data for 2004. Births: Final data for 
    2009. Natl Vital Stat Rep 2011;60:1‑72.
    15. Ahmad‑Nia S, Delavar B, Eini‑Zinab H, Kazemipour S, 
    Mehryar AH, Naghavi M. Caesarean section in the Islamic 
    Republic of Iran: Prevalence and some sociodemographic 
    correlates. East Mediterr Health J 2009;15:1389‑98.
    16. Skjelbred P, Løkken P. Post‑operative pain and inflammatory 
    reaction reduced by injection of a corticosteroid. Acontrolled 
    trial in bilateral oral surgery. Eur J Clin Pharmacol 1982;21:391‑6.
    17. Aasboe V, Raeder JC, Groegaard B. Betamethasone reduces 
    postoperative pain and nausea after ambulatory surgery. 
    Anesth Analg 1998;87:319‑23.
    18. ColomaM, DuffyLL, WhitePF, Kendall TongierW, HuberPJJr. 
    Dexamethasone facilitates discharge after outpatient anorectal 
    surgery. Anesth Analg 2001;92:85‑8.
    19. Romundstad L, Breivik H, Roald H, Skolleborg K, Haugen T, 
    Narum J, et al. Methylprednisolone reduces pain, emesis, 
    and fatigue after breast augmentation surgery: Asingle‑dose, 
    randomized, parallel‑group study with methylprednisolone 
    125 mg, parecoxib 40 mg, and placebo. Anesth Analg 
    2006;102:418‑25.
    20. Romundstad L, Breivik H, Niemi G, Helle A, Stubhaug A. 
    Methylprednisolone intravenously 1 day after surgery 
    has sustained analgesic and opioid‑sparing effects. Acta 
    Anaesthesiol Scand 2004;48:1223‑31.
    21. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative 
    dexamethasone improves surgical outcome after 
    laparoscopic cholecystectomy: A randomized double‑blind 
    placebo‑controlled trial. Ann Surg 2003;238:651‑60.
    22. Afman CE, Welge JA, Steward DL. Steroids for 
    post‑tonsillectomy pain reduction: Meta‑analysis of 
    randomized controlled trials. Otolaryngol Head Neck Surg 
    2006;134:181‑6.
    23. Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, 
    Arotiba GT, Ogunlewe MO. Effects of co‑administered 
    dexamethasone and diclofenac potassium on pain, swelling 
    and trismus following third molar surgery. Head Face Med 
    2005;1:11.
    24. Lin TC, Lui MT, Chang RC. Premedication with diclofenac 
    and prednisolone to prevent postoperative pain and swelling 
    after third molar removal. Zhonghua Yi Xue Za Zhi (Taipei) 
    1996;58:40‑4.
    25. Holte K, Kehlet H. Perioperative single‑dose glucocorticoid 
    administration: Pathophysiologic effects and clinical 
    implications. J Am Coll Surg 2002;195:694‑712.
    26. White PF. The role of non‑opioid analgesic techniques in the 
    management of pain after ambulatory surgery. Anesth Analg 
    2002;94:577‑85.
    27. Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. 
    Dexamethasone for prophylaxis of nausea and vomiting 
    after epidural morphine for post‑caesarean section analgesia: 
    Comparison of droperidol and saline. Br J Anaesth 
    2000;85:865‑8.
  2. 28. Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged 
    postoperative analgesic effect when dexamethasone is added 
    to a nonsteroidal antiinflammatory drug (rofecoxib) before 
    breast surgery. Anesth Analg 2007;105:481‑6.
    29. Song IH, Buttgereit F. Non‑genomic glucocorticoid effects 
    to provide the basis for new drug developments. Mol Cell 
    Endocrinol 2006;246:142‑6.
    30. O’Sullivan BT, Cutler DJ, Hunt GE, Walters C, Johnson GF, 
    Caterson ID. Pharmacokinetics of dexamethasone and its 
    relationship to dexamethasone suppression test outcome 
    in depressed patients and healthy control subjects. Biol 
    Psychiatry 1997;41:574‑84.
    31. Hong JY, Han SW, Kim WO, Kim EJ, Kil HK. Effect of 
    dexamethasone in combination with caudal analgesia on 
    postoperative pain control in day‑case paediatric orchiopexy. 
    Br J Anaesth 2010;105:506‑10.
    32. Splinter W, Roberts DJ. Prophylaxis for vomiting by children 
    after tonsillectomy: Dexamethasone versus perphenazine. 
    Anesth Analg 1997;85:534‑7.
    33. Cardoso MM, Leite AO, Santos EA, Gozzani JL, Mathias LA. 
    Effect of dexamethasone on prevention of postoperative nausea, 
    vomiting and pain after caesarean section: A randomised, 
    placebo‑controlled, double‑blind trial. Eur J Anaesthesiol 
    2013;30:102‑5.
    34. Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM. The use of 
    dexamethasone for preventing postoperative nausea 
    and vomiting in females undergoing thyroidectomy: 
    A dose‑ranging study. Anesth Analg 2000;91:1404‑7.
    35. López‑Olaondo L, Carrascosa F, Pueyo FJ, Monedero P, 
    Busto N, Sáez A. Combination of ondansetron and 
    dexamethasone in the prophylaxis of postoperative nausea 
    and vomiting. Br J Anaesth 1996;76:835‑40.
    36. Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Granisetron/
    dexamethasone combination for reducing nausea and 
    vomiting during and after spinal anesthesia for cesarean 
    section. Anesth Analg 1999;88:1346‑50.
    37. Cook AM, Patterson H, Nicholls J, Huddart RA. Avascular 
    necrosis in patients treated with BEP chemotherapy 
    for testicular tumours. Clin Oncol(R Coll Radiol) 1999;11:126‑7.
Journal of Research in Pharmacy Practice
Volume 2, Issue 3
Summer 2013
Pages 99-104

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