Background: Dexamethasone has analgesic and antiemetic actions that have been documented in the literature. Therefore, we performed a systematic review and meta-analysis to investigate its overall effectiveness in reducing a variety of negative outcomes after cesarean section.
Objectives: To investigate the efficacy and safety of dexamethasone for reducing pain associated with cesarean section, nausea, vomiting, pruritus, postoperative need for analgesia, postoperative antiemetic requests and headache.
Methods: We searched PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science for relevant clinical trials. We then performed a systematic review and meta-analysis, including only randomized, placebo-controlled clinical trials. Our main population target was women undergoing elective cesarean delivery. The intervention under consideration was dexamethasone administered both by intravenous (IV) or subcutaneous (SC) over a variety of doses. The comparator was a placebo. Our main outcomes included: (1) perceptions as indicated by pain scores, (2) occurrence of nausea and (3) occurrence of vomiting. Secondary outcomes included: (4) occurrence of pruritus, (5) need for postoperative analgesia, (6) need for postoperative antiemetic drugs and (7) occurrence of headache. We assessed the quality of included studies using the risk of bias tool described in Cochrane's handbook for systematic reviews of interventions.
Results: We found that dexamethasone seemed to significantly reduce scores for pain at rest (p<0.001), as well as occurrence of nausea (p<0.001) and vomiting (p<0.001). The drug also showed significant reduction of negative symptoms in other secondary outcomes, including need for postoperative analgesia (p<0.001) and postoperative antiemetic drugs (p<0.001). However, the drug showed no significant effect in reducing headache and pruritus or in improving pain at movement scores.
Conclusion: Dexamethasone appears to decrease perception of pain at rest and protects against nausea and vomiting. However, it does not seem effective against headaches or pruritus.
Dexamethasone, cesarean, pain, nausea, vomiting
The authors report no conflict of interest
Copyright © 2021 the authors
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This work is licensed under a Creative Commons Attribution 4.0 License.
Abdelmonem M, Sayed FM, Mohammed OM, Abdeltawab AK, Abdelmonem H, Hosny MM, Masoud AT, Samy A, Abbas AM. Effect of dexamethasone on reducing pain and gastrointestinal symptoms associated with cesarean section: a systematic review and meta-analysis. Proc Obstet Gynecol. 2021 Jun 17;10(2):Article 2 [25 p.]. https://doi.org/10.17077/2154-4751.1517. Free full text article.
Additional FilesFlow diagram (figure 1).png (37 kB)
Risk of bias summary (figure2).png (55 kB)
publication bias pain at rest (Figure 3).png (3 kB)
Vomiting all doses publication bias (figure 4).png (7 kB)
Nausea all doses publication bias (Figure 5).png (7 kB)
pain at movement(figure 6).png (31 kB)
pain at rest(figure 7).png (80 kB)
Nausea (figure 8).png (51 kB)
Vomiting (figure 9).png (49 kB)
Headache (figure 10).png (36 kB)
pruritus (Figure 11).png (9 kB)
resue analgesic (figure 12).png (36 kB)
rescue anti emetic (figure 13).png (42 kB)