Impact of intraoperative dexamethasone after scheduled cesarean delivery

Dexamethasone is an effective analgesic and antiemetic in patients undergoing many surgical procedures, but its effects on pain after cesarean delivery are poorly studied. The aim of this study was to evaluate if routine intraoperative administration of dexamethasone improved pain and decreased postoperative nausea/vomiting after scheduled cesarean delivery.

Electronic medical record data for scheduled cesarean deliveries performed under neuraxial anesthesia before and after a practice change that introduced the routine use of dexamethasone 4 mg IV were obtained. Patients were analyzed based on whether they received routine care (n = 182) or also received dexamethasone (n = 187). The primary outcome was time to first opioid use. Secondary outcomes included postoperative opioid consumption, pain scores, incidence and treatment of postoperative nausea/vomiting, satisfaction, and length of stay.

There was no difference between groups in median time to first postoperative opioid administration, 5.1 [2.1-15.7] h in women receiving only routine care vs. 5.3 [2.8-21.4] h in women that also received dexamethasone; P = 0.13. There were no significant differences in any secondary outcomes including opioid consumption, pain scores, and incidence and treatment of postoperative nausea/vomiting.

This impact study of over 360 patients suggests that routine administration of intraoperative dexamethasone 4 mg IV does not provide additional analgesic benefit after scheduled cesarean delivery in the context of a multimodal postoperative analgesia regimen. Future studies are required to determine if a larger dose or repeated administration influence postoperative analgesia or side effects, or whether certain subsets of patients may benefit.