Preoperative minimum dosage of intravenous dexamethasone as a helper to nonsteroidal antiinflammatory medicine in C-section postoperative pain management
Originally published in El Dolor Magazine 2010;19(54):12-7.
DOI:
https://doi.org/10.47924/neurotarget2011290Keywords:
postoperative analgesia, cesareansection, dexamethasone, preventive analgesia, intravenous analgesiaAbstract
Cesarean section (CS) is a major abdominal surgery that causes moderate to severe pain during the postoperative period. A number of analgesic methods have been used based on two or more drug combinations. The objective of this work was to evaluate the usefulness of dexamethasone as an adjuvant medication to nonsteroidal antiinflammatory drugs (NSAIDs) in postoperative pain management for CS. The study included full term pregnant patients programmed to undergo CS under spinal anesthesia (SA) for whom there was no regional anesthesia or dexamethasone contraindication. Patients were divided in three groups: Group 1 (n=18): 8 mL of physiological saline solution (PSS) passed five minutes before SA; Group 2 (n=18): 0.05 mg/Kg of Dexamethasone in 8 mL of PSS passed five minutes before the SA; Group 3(n=18): 0.1 mg/Kg of dexamethasone in 8 mL of PSS passed five minutes before the SA. For postoperative analgesia patients received metamizole sodium and ketoprofen. As a rescue analgesic therapy, intravenous morphine was administered. Patients and their newly born babies were tested to measure glycemia levels. Postoperative pain occurred after 1, 4, 8, 16, 24 and 48 hours and was measured using the analogic visual scale (AVS). The use of morphine, impact of negative effects, postoperative complications and patients‘ level of satisfaction were registered. The study groups showed no differences in demographic parameters. Measurements of glycemia levels in both, mothers and babies were similar in all three groups. Postoperative AVS measurement was significantly lower in groups 2 and 3 compared to those in group 1 between 4 hours and 16 hours during the postoperative period. Morphine consumption in groups 2 and 3 was lower compared to group 1. This prospective, randomized, and double blind clinical trial showed that a 0.05 mg/Kg dose of preoperative intravenous dexamethasone reduces postoperative pain when in association with (NSAIDs) (metamizole sodium and ketoprofen), improving the quality of postsurgery analgesia and post C-section level of satisfaction.
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References
Bonica JJ, McDonald JS. The pain and childbirth. In: Bonica JJ, editor. The management of pain. 2nd edition. Philadelphia: Lea & Febiger; 1990. p. 1313-43.
Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America. 2005;23(1):21-36.
Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med. 2005;1:11.
Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev. 2000;21(1):55-89.
Wei JL, Kasperbauer JL, Weaver AL, Boggust AJ. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope. 2002;112(1):87-93.
Liu K, Hsu CC, Chia YY. The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg. 1999;89(5):1316-8.
Sanchez-Ledesma MJ, López-Olaondo L, Pueyo FJ, Carrascosa F, Ortega A. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg. 2002;95(6):1590-5.
Park SH, Han SH, Do SH, Kim JW, Rhee KY, Kim JH. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double- lumen endobronchial tube. Anesth Analg. 2008;107(6):1814-8.
Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery. Anesth Analg. 2007;105(2):481-6.
Moore PA, Brar P, Smiga ER, Costello BJ. Preemptive rofecoxib and dexamethasone for prevention of pain and trismus following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(2):E1-7.
Stewart R, Bill R, Ullah R, McConaghy P, Hall SJ. Dexamethasone reduces pain after tonsillectomy in adults. Clin Otolaryngol Allied Sci. 2002;27(5):321-6.
Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study. Anesth Analg. 2006;102(2):605-9.
Koç S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: a randomized controlled trial. Anesth Analg. 2007;105(4):1137-42.
Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Annals of Surgery. 2008;248(6):1060-6.
Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, et al. Parenteral dexamethasone for acute severe migraine headache: metaanalysis of randomised controlled trials for preventing recurrence. BMJ. 2008;336(7657):1359-61.
Kim MS, Coté CJ, Cristoloveanu C, Roth AG, Vornov P, Jennings MA, et al. There is no dose-escalation response to dexamethasone (0.0625-1.0 mg/ kg) in pediatric tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain, shortening time to first liquid intake, or the incidence of voice change. Anesth Analg. 2007;104(5):1052-8.
Karst M, Kegel T, Lukas A, Lüdemann W, Hussein S, Piepenbrock S. Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery. 2003;53(2):331-6; discussion 336-7.
Aminmansour B, Khalili HA, Ahmadi J, Nourian M. Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain. Spine (Phila Pa 1976). 2006;31(21):2415-7
Kardash KJ, Sarrazin F, Tessler MJ, Velly AM. Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg. 2008;106(4):1253-7.
Ranta PO, Ala-Kokko TI, Kukkonen JE, Ohtonen PP, Raudaskoski TH, Reponen PK, et al. Incisional and epidural analgesia after caesarean delivery: a prospective, placebo- controlled, randomised clinical study. Int J Obstet Anesth. 2006;15(3):189-94.
American Society of Anesthesiologists (ASA). Practice guidelines for obstetric anesthesia: an update report by the American Society for Anesthesiologist Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106:843-63.
Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, Akbarian-Tefaghi N. The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of meperidine. Anesth Analg. 2007;104(4):987-9.
Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo- controlled trial. Ann Surg. 2003 November; 238(5): 651-6.
Dürsteler C, Miranda HF, Poveda R, Mases A, Planas E, Puig MM. Synergistic interaction between dexamethasone and tramadol in a murine model of acute visceral pain. Fundam Clin Pharmacol. 2007;21(5):515-20.
Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America. 2005;23(1):185-202.
Contreras-Domínguez V, Carbonell-Bellolio P. Evaluación de la administración preoperatoria de dos dosis de dexametasona sobre la analgesia postoperatoria en la reconstrucción de ligamento cruzado anterior de rodilla. El Dolor. 2009;18(52):30-4.
Lavand'homme P. Postcesarean analgesia: effective strategies and association with chronic pain. Curr Opin Anaesthesiol. 2006;19(3):244-8.
Lachance M, Lacroix Y, Audet N, Savard P, Thuot F. The use of dexamethasone to reduce pain after tonsillectomy in adults: a double-blind prospective randomized trial. Laryngoscope. 2008;118(2):232-6.
Tan PH, Liu K, Peng CH, Yang LC, Lin CR, Lu CY. Anesth Analg 2001;92:228- 32. The effect of dexamethasone on postoperative pain and emesis after intrathecal neostigmine. Anesth Analg. 2001;92:228-32.
Mathiesen O, Jacobsen LS, Holm HE, Randall S, Adamiec-Malmstroem L, Graungaard BK, et al. Pregabalin and dexamethasone for postoperative pain control: a randomized controlled study in hip arthroplasty. Br J Anaesth. 2008;101(4):535-41.
Mathiesen O, Rasmussen ML, Dierking G, Lech K, Hilsted KL, Fomsgaard JS, et al. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy: a randomized clinical trial. Acta Anaesthesiol Scand 2009;53(2):227-35.
Giannoni C, White S, Enneking FK. Does dexamethasone with preemptive analgesia improve pediatric tonsillectomy pain? Otolaryngol Head Neck Surg. 2002;126(3):307-15.
Orellana A, Salazar E. Evaluación clínica de la terapia con dexametasona e ibuprofeno en la cirugía de los terceros molares retenidos. Acta Odontol Venez. 2007;45(1):54-60.
Czarnetzki C, Elia N, Lysakowski C, Dumont L, Landis BN, Giger R, et al. Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial. JAMA. 2008;300(22):2621-30.
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Copyright (c) 2011 Andrea Sánchez, Víctor Contreras, Paulina Carbonell, Vicente Bejar, Diego Vergara, Ricardo Fuentealba, Carlos Bolbarán, Juan Carlos Barra
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