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Created March 23, 2024, last updated 9 months ago.
Collection: 166, Score: 3, Trend score: 0, Read count: 439, Articles count: 7, Created: 2024-03-23 20:46:06 UTC. Updated: 2024-03-23 21:07:30 UTC.Notes
- Does peri-operative intravenous dexamethasone reduce pain and opioid consumption after caesarean delivery? YES
- Are the effects statistically significant? YES
- Are the effects clinically significant? Possibly, though pain scores are only modestly improved and the reduction in opioid use is only small.
- Are the findings applicable to my patient population? Possibly, though the majority of studies were performed in Middle East, Asian & South Asian hospitals, and with diverse post-operative analgesic regimes.
- Is peri-operative dexamethasone safe? Probably, though few studies were adequately powered to identify less-common potential side effects, such as infection or delayed wound healing.
- Quality of evidence is low to modest. Notably, the primary outcome for most studies was PONV reduction, not post-operative pain.
- Should this evidence result in routine practice change? Probably not at this stage. IV dexamethasone may however be an appropriate intervention in select patient groups.
Daniel Jolley
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Collected Articles
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Intravenous dexamethasone modestly reduces post-caesarean section pain.
pearl -
Cesarean section is the most frequent surgical intervention, and pain following cesarean delivery unfortunately remains a common issue. The purpose of this article is to highlight the most effective and efficient options for postcesarean analgesia and to summarize current guidelines. ⋯ Adequate analgesia following cesarean delivery is still underused. Simple measures, such as multimodal analgesia regimens should be standardized according to institutional circumstances and defined as part of a treatment plan. Neuraxial morphine should be used whenever possible. If it cannot be used, abdominal wall blocks or surgical wound infiltration are good alternatives.
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Practice Guideline
PROSPECT guideline for elective caesarean section: updated systematic review and procedure-specific postoperative pain management recommendations.
Caesarean section is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and patient satisfaction as well as breastfeeding success and mother-child bonding. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after elective caesarean section under neuraxial anaesthesia. A systematic review utilising procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. ⋯ Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations. Some interventions were not recommended due to insufficient, inconsistent or lack of evidence. Of note, these recommendations may not be applicable to unplanned deliveries or caesarean section performed under general anaesthesia.
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Worldwide, the most performed surgical intervention is cesarean section. Hence, post-cesarean pain is a common problem with significant health and economic impact on the individual patient and society. ⋯ To facilitate recovery and temper the side effects of potent analgesic drugs such as opioids, multimodal analgesia is currently advocated, and clear international guidelines and recommendations have recently been described. In the present overview, we will discuss the most recent guidelines and evaluate various analgesic interventions.
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J Educ Health Promot · Jan 2022
Effects of intrathecal and intravenous dexamethasone on complications associated with intrathecal morphine after cesarean section: A comparative study.
Pain and nausea and vomiting are of serious complications following the use of opiates after surgery, especially cesarean section. Control of postoperative complications is one of the necessities of quality promotion of health-care system. Medications with few side effects such as corticosteroids including dexamethasone can be an appropriate option. In addition, the route of administration can have a significant effect on the effectiveness of the drug. The aim of the present study was to compare the effects of intrathecal with intravenous dexamethasone in reducing the complications associated with intrathecal morphine after cesarean section. ⋯ Dexamethasone was effective to reduce opiate complications after cesarean section. Establishing a suitable association between dexamethasone half-life, efficacy, type of use, and time of use can result the best outcomes and promote patients' satisfaction in cesarean section.
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Curr Rev Clin Exp Pharmacol · Jan 2021
Clinical TrialComparison of the Effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia.
Postoperative Nausea and Vomiting (PONV) is a common complication associated with the use of anesthesia. Several antiemetics are used to reduce the incidence and severity of PONV. The aim of this study was to investigate the role of dexamethasone and ondansetron to treat PONV in patients undergoing cesarean section (c-section) under spinal anesthesia. ⋯ Based on the results of this study, ondansetron had a significant effect on the alleviation of postoperative nausea and vomiting, as compared to dexamethasone in C-section surgical candidates.
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Randomized Controlled Trial
Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section.
Postoperative nausea and vomiting (PONV) are common symptoms after cesarean delivery (CD) that affect patients outcomes and satisfaction. The treatment of choice is still evolving, therefore, we aimed to evaluate PONV of combined paracetamol-dexamethasone vs. paracetamol alone. ⋯ Dexamethasone added to paracetamol might not improve pain and vomiting after cesarean delivery comparison with just paracetamol. But it can be effective for reducing the score of nausea after the surgery.