Postoperative analgesic effects of intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Ethiopia, 2023: a double-blind randomized controlled trial

Abstract

Background: The use of cesarean section worldwide has increased to unprecedented levels. In Ethiopia, the cesarean section delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. The administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed. Objective: This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at ****. Methodology: A double-blinded RCT was done on 112 patients undergoing elective cesarean section under spinal Anesthesia who were allocated randomly into normal saline and dexamethasone groups. A total analgesic consumption, time to first analgesic request, and postoperative pain score with NRS were followed for 24 hours in both groups. Shapiro Wilk’s were used to check normality. Independent samples t-test was used for the comparison of means between groups, Mann Whitney U test for non-normally distributed data, and chi-square for categorical variables, and P-value <0.05 was considered statistically significant with a power of 80%. Result: The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group at 2hr, at 4hr, at 6hr, at 12hr, at 18hr and at 24hr with a statically significant P-value<0.05. There was also a significant difference in the time to the first rescue analgesic request time between the two groups; with the dexamethasone group (Median=347.5 min) and the Normal saline (Median=230 min) with P=0.001. Conclusion and recommendation: We conclude that preoperative administration of 8mg dexamethasone prolongs the first analgesic request time, decreases postoperative tramadol and diclofenac consumption, and decreases postoperative pain score. We recommend that researchers do further RCT with a different dose of dexamethasone and on a multicenter basis.