Intravenous dexamethasone modestly reduces post-caesarean section pain.

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• Narinder Pal Singh, MakkarJeetinder KaurJK, Neha Yadav, Basavana Gouda Goudra, and Preet Mohinder Singh.
• From the Department of Anaesthesia, MMIMSR, MM (DU), Mullana-Ambala (NPS, NY), Department of Anaesthesia and Intensive care, Postgraduate Institute of Medical Education and Research, Chandigarh, India (JKM), Department of Anaesthesia, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (BGG) and Department of Anaesthesia, Washington University, Saint Louis, Misssouri, USA (PMS).
• Eur J Anaesthesiol. 2022 Jun 1; 39 (6): 498510498-510.

BackgroundAnalgesic efficacy of intravenous dexamethasone has not been well defined after caesarean delivery. We performed a systematic review and meta-analysis to evaluate the impact of peri-operative dexamethasone administration on postoperative pain after caesarean delivery.ObjectivesWe investigated the impact of perioperative intravenous dexamethasone on postoperative pain after caesarean delivery. The two primary outcomes of interest were early (4 to 6 h) resting pain scores and time to first rescue analgesia.DesignA systematic review and meta-analysis of randomised controlled trials (RCTs).Data SourcesPubMed, EMBASE, Scopus and the Cochrane central registers of controlled trials were searched to identify RCTs from inception to April 2021.Eligibility CriteriaProspective RCTs comparing the role of intravenous dexamethasone with non-active control were eligible for inclusion. Exclusion criteria included trials comparing various doses of dexamethasone without any control treatment arm, dexamethasone with other active drugs and trials comparing different routes of dexamethasone, for example, wound infiltration.ResultsThirteen RCTs constituting of 988 parturients undergoing caesarean delivery were included. Patients receiving dexamethasone had lower pain scores at rest at 4 to 6 h after surgery, mean difference -1.29 [95% confidence interval (CI), -1.85 to -0.73], P < 0.0001, with low quality of evidence (I2 = 94%). Moderate quality of evidence (I2 = 17%) suggested that the time to first rescue analgesia in the dexamethasone group was significantly longer, mean difference 2.64 h (95% CI, 1.85 to 3.42), P  < 0.0001. Trial sequential analysis for pain scores suggested the benefit of dexamethasone; however, the requisite information size (RIS) could not be reached, whereas RIS was adequate for time to rescue analgesia. Significant reduction in pain scores at all times and opioid consumption at 24 h with dexamethasone were observed with sparse reporting on adverse effects.ConclusionPeri-operative intravenous dexamethasone was associated with a significant decrease in postoperative pain scores at rest and a longer time to first rescue analgesia, along with a small but statistically significantly reduced opioid consumption after caesarean delivery compared with nonactive control.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

This article appears in the collection: Does dexamethasone reduce post-caesarean section pain?.

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