Spinal Anesthesia, Cesarean Section Pain, Postoperative Pain
Conditions
Keywords
Dexamethasone, Postoperative analgesia, Lower segment cesarean section, Spinal anesthesia, Rescue analgesia, Corticosteroid, Cesarean Section
Brief summary
This study looked at whether giving a single dose of dexamethasone (a steroid medicine, 8 mg given into the vein) before a cesarean section could reduce pain after the operation. Eighty women having a planned cesarean section under spinal anesthesia at KRL Hospital, Islamabad were divided into two equal groups by chance. One group received dexamethasone through a drip before the procedure; the other group received a harmless salt-water solution (normal saline) as a comparison. Pain levels were measured using a 0-10 pain scale at 2, 6, 12, and 24 hours after surgery. The study also recorded how long it took before patients needed an extra painkiller. The group that received dexamethasone reported significantly less pain at 6, 12, and 24 hours after surgery, and far fewer patients in that group needed additional pain relief (7.5% vs 65%). The drug was well tolerated with no major side effects. The findings suggest that a single pre-operative dose of dexamethasone is a simple and effective way to improve pain control after cesarean section.
Detailed description
Postoperative pain following lower segment cesarean section (LSCS) remains a significant clinical concern, particularly as spinal anesthesia wears off within the first few post-operative hours. Dexamethasone, a corticosteroid with known anti-inflammatory and analgesic properties, has been studied as an adjunct for postoperative pain control in various surgical settings. This randomized controlled trial enrolled 80 ASA I-II patients aged 18-40 years undergoing elective LSCS under spinal anesthesia. Patients were randomized into two groups (n=40 each) using non-probability consecutive sampling. Group A received intravenous dexamethasone 8 mg (2 ml) prior to induction; Group B received intravenous normal saline 0.9% (2 ml) as placebo. Standard spinal anesthesia was administered to all participants. Pain intensity was assessed using the Visual Analogue Scale (VAS, 0-10) at 2, 6, 12, and 24 hours postoperatively. Rescue analgesia was administered when VAS exceeded 4. Time to first rescue analgesia was recorded as a secondary outcome.
Interventions
Single intravenous dose of dexamethasone 8 mg (2 ml) administered prior to induction of spinal anesthesia. Applied to: Dexamethasone Group (Arm 1).
Single intravenous dose of normal saline 0.9% (2 ml) administered prior to induction of spinal anesthesia, serving as placebo control. Applied to: Placebo Group (Arm 2).
Sponsors
KRL Hospital, Islamabad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
1. Female patients aged 18-40 years 2. Scheduled for elective lower segment cesarean section (LSCS) 3. Spinal anesthesia planned and suitable 4. ASA physical status Class I or II 5. Gestational age ≥ 37 weeks 6. Willing to participate and able to provide written informed consent
Exclusion criteria
1. Known allergy or hypersensitivity to dexamethasone or any corticosteroid 2. Diabetes mellitus or uncontrolled hyperglycemia 3. Current or recent (within 4 weeks) corticosteroid use 4. Contraindication to spinal anesthesia (coagulopathy, infection at puncture site, patient refusal) 5. Emergency cesarean section 6. Systemic infection or sepsis 7. Significant hepatic, renal, or cardiovascular disease 8. Peptic ulcer disease 9. Psychiatric illness 10. Failure of spinal anesthesia requiring conversion to general anesthesia 11. BMI \> 35 kg/m²
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Intensity | 2, 6, 12, and 24 hours postoperatively | Pain intensity measured using the Visual Analogue Scale (VAS, 0-10; 0 = no pain, 10 = worst pain) at 2, 6, 12, and 24 hours after surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to First Rescue Analgesia | Within 24 hours postoperatively | Time elapsed (in hours) from end of surgery to first administration of rescue analgesia, given when VAS score exceeded 4. |
| Proportion of Patients Requiring Rescue Analgesia | Within 24 hours postoperatively | Number of participants in each group who required at least one dose of rescue analgesia within 24 hours of surgery. |
Countries
Pakistan
Outcome results
None listed