Effectiveness of Single Intravenous Dexamethasone in Prolongation of Spinal Anesthesia for Postoperative Analgesia in Elective Cesarean Section: A Systematic Review of Randomized Controlled Trials

Abstract

Background

The analgesic effectiveness of a single perioperative dose of dexamethasone is not clearly defined. The administration of systemic medication like dexamethasone, opioids, and non-steroidal anti-inflammatory drugs has a positive effect on the prolongation of postoperative analgesia after cesarean section under spinal anesthesia. A single-dose administration of dexamethasone with moderate to high dose reduces postoperative pain, reduces opioid consumption, and prolongs spinal anesthesia after cesarean delivery.

Objective

The aim of this systematic review was to investigate the effectiveness of single intravenous dexamethasone in prolongation of spinal anesthesia for postoperative analgesia in elective cesarean section.

Methods

We conducted a search on PubMed, Google Scholar, the Cochrane Library, Hinari, and review articles on the effectiveness of intravenous dexamethasone for extending spinal anesthesia during elective cesarean sections, until June 2023. The searches were conducted by using keyword (IV dexamethasone OR/AND analgesia OR postoperative pain AND cesarean section OR child birth AND prolongation of spinal anesthesia). The articles included describe the analgesic efficacy of dexamethasone for prolongation of spinal anesthesia during cesarean section.

Results

A total of 25,384 papers were found using different searching methodologies from different electronic databases. The EndNote reference manager was used to remove duplicates, and 438 articles were selected for screening. Of those, 57 were included for critical evaluation, and 49 were removed with justification. The effectiveness of IV dexamethasone on the prolongation of spinal anesthesia and postoperative analgesia in women undergoing cesarean delivery is the subject of eight RCT studies on 628 parturients that are presented in the chosen journal articles from various countries.

Conclusion

Intravenous dexamethasone administration immediately after clamping of the umbilical cord prolongs the duration of spinal block in patients undergoing cesarean sections and has a significant impact on reduction of postoperative pain severity, opioid consumption, and other pain requirements. When high-dose dexamethasone is administered intravenously, it can overcome complications that may arise after severe pain and increase patient satisfaction by extending the duration of postoperative analgesia and sensory block.

Keywords:

• dexamethasone
• prolongation
• spinal anesthesia
• analgesia
• caesarean section systematic review

Abbreviation

ASA, American Society of Anesthesiologists; CS, cesarean section; GCP, good clinical practice; h, hour; HUCSH, Hawassa University Comprehensive Specialized Hospital; IV, intravenous; LA, local anesthetics; LSCS, lower segment cesarean section; MA, meta-analysis; mg, milligram; mg/kg, milligram per kilogram; PICO, population, intervention, control, and outcome; PRISMA, preferred reporting items of systematic review of meta-analysis; RCT, randomized controlled clinical trials; SA, spinal anesthesia; SR, systematic review; WHO, World Health Organization.

Accessibility of Information and Resources

The corresponding author provides data upon reasonable request.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No funding was received for this study.