THE EFFICACY OF INTRATHECAL DEXAMETHASONE TO PREVENT EARLY COMPLICATIONS OF SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION
Abstract
Spinal anaesthesia is commonly used for elective caesarean section. But it has some disadvantages and complications in intra- and postoperative period.
The aim of this study was to explore the efficacy of intrathecal or intravenous dexamethasone to prevent some early complications of spinal anaesthesia such as arterial hypotonia, nausea, vomiting, bradycardia, shivering etc.
Material and methods: there were examined 154 healthy, not obese women, ASA I–II, 18–36 years old, 36–40 weeks of gestation, undergoing elective caesarean section under spinal anaesthesia. All patients were divided into three equal groups for randomized, prospective, double-blinded, placebo-controlled clinical trial.
The women of each group received intrathecal hyperbaric bupivacaine 0.5 % 10 mg. Group B (n=51) additionally received intrathecal 1 ml of normal saline=placebo; Group BD (n=52) additionally received 4 mg (1 ml) intrathecal dexamethasone, and Group D (n=51) received 8 mg intravenous dexamethasone directly after spinal puncture. The patients were evaluated for blood pressure, heart rate, nausea, vomiting, shivering or other complications during intra- or postoperative period (24 h). The complications that required medicines correction were recorded and cured.
Results: the addition of intrathecal dexamethasone in Group BD vs Group B significantly decreased frequency and manifestations of arterial hypotonia and nausea (Pearson's χ2 =0.486 and χ2=0.479, p<0.05) in intra- and postoperative period after the spinal anaesthesia in elective caesarean section. Intrathecal dexamethasone in Group BD vs Group B significantly reduced shivering (Pearson's χ2=0.316, p<0.05) in intra- and postoperative period, and significantly didn`t impact on vomiting and bradycardia.
Conclusions: the addition of 4 mg intrathecal dexamethasone as an adjuvant for spinal anaesthesia can significantly decrease frequency and manifestations of arterial hypotonia and nausea, reduce shivering during perioperative period. The addition of 8 mg intravenous dexamethasone has not the same quality.
Downloads
References
Chooi, C., Cox, J. J., Lumb, R. S., Middleton, P., Chemali, M., Emmett, R. S. et. al. (2020). Techniques for preventing hypotension during spinal anaesthesia for caesarean section. The Cochrane database of systematic reviews, 7 (7), CD002251.
Fitzgerald, J. P., Fedoruk, K. A., Jadin, S. M., Carvalho, B., Halpern, S. H. (2019). Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials. Anaesthesia, 75 (1), 109–121. doi: http://doi.org/10.1111/anae.14841
Kinsella, S. M., Carvalho, B., Dyer, R. A., Fernando, R., McDonnell, N. et. al. (2017). International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia, 73(1), 71–92. doi: http://doi.org/10.1111/anae.14080
Swain, A., Nag, D. S., Sahu, S., Samaddar, D. P. (2017). Adjuvants to local anesthetics: Current understanding and future trends. World Journal of Clinical Cases, 5 (8), 307–323. doi: http://doi.org/10.12998/wjcc.v5.i8.307
Kirksey, M. A., Haskins, S. C., Cheng, J., Liu, S. S. (2015). Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLOS ONE, 10 (9), e0137312. doi: http://doi.org/10.1371/journal.pone.0137312
Albrecht, E., Chin, K. J. (2020). Advances in regional anaesthesia and acute pain management: a narrative review. Anaesthesia, 75 (S1), 101–110. doi: http://doi.org/10.1111/anae.14868
Ryu, C., Choi, G. J., Park, Y. H., Kang, H. (2019). Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia. Medicine, 98 (1), e13947. doi: http://doi.org/10.1097/md.0000000000013947
Moore, S. G. (2018). Intravenous Dexamethasone as an Analgesic: A Literature Review. AANA journal, 86 (6), 488–493.
Maged, A. M., Deeb, W. S., Elbaradie, S., Elzayat, A. R., Metwally, A. A., Hamed, M., Shaker, A. (2018). Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology, 57 (3), 346–350. doi: http://doi.org/10.1016/j.tjog.2018.04.004
Haque, M. M., Aleem, M. A., Haque, F. H., Siddique, A. B., Afrose, R. Efficacy of 0.5 % Hyperbaric Bupivacaine with Dexamethasone versus 0.5 % Hyperbaric Bupivacaine alone in Spinal Anaesthesia for Patient Undergoing Lower Abdominal Urological and Lower Limb Orthopedic Surgeries (2018). Mymensingh Medical Journal, 27 (2), 375–381.
Imeh, A., Olaniyi, O., Simeon, O., Omotola, O. (2014). Dexamethasone versus a combination of dexamethasone and ondansetron as prophylactic antiemetic in patients receiving intrathecal morphine for caesarean section. African Health Sciences, 14 (2), 453–459. doi: http://doi.org/10.4314/ahs.v14i2.23
Pehora, C., Pearson, A. M., Kaushal, A., Crawford, M. W., Johnston, B. (2017). Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database of Systematic Reviews, 11 (11). doi: http://doi.org/10.1002/14651858.cd011770.pub2
Copyright (c) 2020 Nataliya Pyasetska

This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.