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Background and Aims Effective analgesia after CS is essential to enhance recovery. Recent PROSPECT guidelines highlighted the importance of multimodal analgesia including paracetamol, NSAIDs, regional anesthesia and IV Dexamethasone.1 Usually, doses of Dexamethasone are 0.2mg/kg) seem to generate analgesic superiority.2,3 This randomized, double-blind study aimed to compare HIGH- versus LOW-dose Dexamethasone for post-CS analgesia.
Methods Following ethical approval and informed consent, 210 patients undergoing CS were randomized to 5mg or 2x25mg of IV-Dexamethasone. Multimodal analgesia was given in both groups including paracetamol, NSAIDs, wound infiltration and bilateral ilio-inguinal nerve block. Opioids were given as rescue. In the LOW-group 5mg IV-Dexamethasone was given after delivery. In the HIGH-group 25mg IV-Dexamethasone was given after delivery and 24hours later. Primary endpoint was the cumulated NRS-pain scores at movement 4-48 hours after CS quantified as area under the curve (AUC). Secondary endpoints included pain scores at rest, patient satisfaction, rescue analgesics, side-effects and functional recovery.
Results In the HIGH-group the hourly AUC pain score at movement was significantly reduced by 15% from 3.11±1.14 to 2.65±1.25 (p=0.0011), and pain scores at rest and highest pain scores were lower. Less patients required rescue opioids (75% vs 58%, p=0.011), morphine consumption was reduced (9.1 to 5.2mg, p=0.0003) and functional recovery improved. Glycemia and wound healing were normal in both groups.
Conclusions Compared to a single 5mg dose of Dexamethasone, 2 x 25mg Dexamethasone added to multimodal analgesia provided superior analgesia with lower opioid consumption without an increase in side-effects.
Roofthooftetal. Anaesthesia. 2021;76: 665–680.
Lunnetal. Brit J Anaesth. 2011;106: 230–238.
VandeVeldeMetal. Eur J Anaesthesiol. 2023;40: 151–152.
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