Dexamethasone as an Adjuvant to Diclofenac and Acetaminophen for Post-Cesarean Pain Management: A randomized Placebo-Controlled Trial

Background & Objective: The commonly used analgesia for post caesarean pain include combination regimens containing acetaminophen, non-steroidal anti-inflammatory agents (NSAIDs) and opioids. The objective of this study is inter alia to determine the effects of dexamethasone as adjuvant to commonly used NSAIDs for post-caesarean pain management.Materials & Methods: One hundred and eighty-eight participants slated for caesarean delivery under spinal anesthesia were randomized into two groups of 94 participants each. One group received 2ml intravenous 8mg dexamethasone while the second group received 2ml of intravenous sterile water as placebo. Both groups received similar doses of intramuscular acetaminophen and diclofenac. Intramuscular pentazocine at a dose of 0.5mg/kg body weight was used as rescue analgesia. Primary outcome was the mean summed pain intensity difference (MDPID) in the two groups while the secondary outcomes include the needs and frequency of rescue analgesia, and the levels of maternal satisfaction. P-value set as ≤0.05.Results: The mean summed pain intensity difference (MSPID) at 24hours post-caesarean was higher in the dexamethasone group, (29.27±18.10 versus 24.24±13.14, p=0.036). The percentage of the participants that required rescue analgesia in the dexamethasone group was less (60.6% versus 76.1%, p=0.024). The Overall levels of maternal satisfaction were comparable in both groups.Conclusion: Intraoperative dexamethasone given intravenously as adjuvant to intramuscular diclofenac and acetaminophen minimizes opioid administration within the first 24hours after caesarean section.