Effect of Dexamethasone on Prevention of Postoperative Nausea, Vomiting, and Pain After Cesarean Section

Abstract

between physician and patient, deliberation on options, and final decision. Open-ended questions were designed to elicit the patient's concerns about neuraxial analgesia and included her reasons for not planning to use neuraxial analgesia. Responses were recorded verbatim. In the analysis of the responses, data were reviewed line-by-line and codes were assigned as concepts were identified. This continued until no concepts requiring new codes were identified.Of 520 women approached for participation, 509 consented; 62% were white, 23% were Hispanic, and 14% were African American. Of these 509, 198 women (39%) expressed concerns about neuraxial analgesia, which were categorized as those relating to maternal health and those related to fetal health. The main worry with fetal health was transfer of drugs to the infant. Maternal concerns centered on misunderstandings about neuraxial analgesia, general fears about the procedure, and lack of trust in providers. Specific concerns were slowing down labor, risk of cerebral palsy for the infant, increased risk of needing a cesarean section, or inability to be mobile during labor. Fears included concerns related to a needle in the spine, back pain, or paralysis. Lack of trust in the providers included having no support person in the room during the epidural placement. Reasons for not planning use of neuraxial analgesia were desire for unmedicated childbirth (23% of women), concerns about risks of the procedure (46%), high pain threshold that precluded the need for neuraxial analgesia, and recommendations from others against having the procedure.Many women who do not plan to use neuraxial analgesia seem to base their decision on inaccuracies or misunderstandings about the risks of the procedure. Improved patient-provider communication, particularly providing accurate information and addressing a patient's misconceptions, could enhance the quality of care and provide for a more informed decision-making process.A lthough spinal morphine is an effective form of postoperative analgesia after cesarean section (CS), it has dose-related side effects, including pruritus, nausea, and vomiting. The development of any of these can greatly affect the patient's satisfaction and jeopardize the mother's ability to care for her infant. Dexamethasone (DEX) given immediately before surgery can reduce the incidence of nausea and vomiting in patients undergoing epidural or spinal anesthesia that includes neuraxial morphine. When DEX is used, the dose of spinal morphine might also be able to be decreased, which might contribute further to reducing the incidence of postoperative nausea and vomiting (PONV). This double-blind, randomized, placebocontrolled trial was designed to evaluate whether a single dose of DEX given immediately before surgery would prevent PONV in patients having CS under spinal anesthesia with morphine.Parturients at full-term undergoing elective CS were randomly allocated to receive either a single dose of 10 mg DEX in 100 mL 0.9% saline immediately before surgery or a placeb...

The Effect of Single Dose Dexamethasone on Postoperative Pain and Post Operative Nausea Vomiting in Patients Undergoing Breast Surgery Under General Anaesthesia

“…Antiemetic dexamethasone works by blocking the release of neurotransmitters endorphin and enkephalin, as well as the gastrointestinal hormones prostaglandin and serotonin (17). Although the minimal dose of dexamethasone has been reported from 2.5 mg for gynecologic procedures to 5 mg for thyroidectomy, the impact of varying doses of glucocorticoids on decrease of PONV has been observed in several studies (18,19). After a caesarean section under spinal anesthesia and morphine, Cardoso et al (2013) found that dexamethasone decreased the cumulative incidence of nausea and vomiting on the first postoperative day and decreased pain ratings (20).…”

Outcome following the introduction of a procedure specific pain management program for caesarean section

“…Side effects include prolonged motor blockade, nausea and vomiting in neostigimine use 17 and unacceptable hypotension, sedation, bradycardia, vomiting and prolonged motor block 18 in clonidine use. Dexamethasone (1.25 -20mg) 19 had been shown to decrease VAS at 24hrs, decrease pain on movement and decrease morphine consumption, decrease nausea and vomiting without increasing the rate of infection. Postoperative hyperglycemia may occur.…”