Dexamethasone for Post-operative Pain After Cesarean Delivery Under Neuraxial Anesthesia.

Postoperative pain in patients who have undergone a cesarean delivery is a determining factor in the quality and duration of their hospital stay. Suboptimal analgesia can lead to prolonged hospitalization and chronic pain, which can result in chronic use of pain medication. Treatment of post-operative pain after cesarean delivery uses intrathecal morphine, and the use of opioids as needed post-operatively. However, the side effects associated with opioids limit the doses used, their analgesic efficacy, and adversely affect the postoperative experience of patients. The multimodal approach to postoperative pain allows for analgesia that acts on different pain mechanisms while limiting the adverse effects of different drugs. The potential benefits of dexamethasone as a co-analgesic in women who have had a cesarean section are all the more interesting because of its minimal adverse effects compared to opioids. Its low cost, its effectiveness as antiemetic prophylaxis, and its impact on the general condition of patients make dexamethasone even more attractive.

In this randomised controlled trial, 100 patients are to be recruited and randomised to one of two groups. Both groups will receive standard treatment. In addition to standard treatment, the first group will receive dexamethasone 8 mg IV after umbilical cord clamping and the other group will receive a placebo.

The patients will be followed for 24 hours post-operatively. Their pain levels at rest and during movement will be recorded on an 11 point pain scale. The dose of hydromorphone used in the first 24 hours will be recorded. The patients are also asked to complete the QOR-40 questionnaire, which aims to assess the quality of their postoperative recovery. The primary outcome is the pain on an 11 point scale at the first rise 6 hours post-operatively.

The investigators hypothesize that dexamethasone will improve pain scores and diminish opioid use in the first 24 hours post-operatively.

Inclusion criteria

• Age ≥ 18 years
• Cesarean delivery
• Planned spinal or combined neuraxial anesthesia
• Presence of an investigator in the delivery room
• Pregnancy > 34 weeks gestation

Exclusion criteria

• Cesarean delivery under general anesthesia
• Inability to understand French or English
• Allergy or hypersensitivity to dexamethasone
• Allergy to hydromorphone
• Allergy to NSAIDs
• Acute kidney injury or chronic kidney failure
• Preeclampsia
• Extremely urgent cesarean section
• Urgent cesarean section with non-reassuring fetal monitoring
• Known maternal heart disease
• High-grade placental abnormality
• Diabetes (pregnancy or pre-existing)
• Systemic infection, sepsis, fever
• Regular use of dexamethasone in the last year
• Weight greater than 120 kg and less than 70 kg
• Height less than 150 cm
• Chronic pain and/or chronic use of opioids