THE EFFICACY OF INTRATHECAL DEXAMETHASONE TO PREVENT EARLY COMPLICATIONS OF SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION

Keywords: dexamethasone, spinal anaesthesia, caesarean section, adjuvant, arterial hypotension, complications

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 χ=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

Download data is not yet available.

Author Biography

Nataliya Pyasetska, Kyiv City Center of Reproductive and Perinatal Medicine; Shupyk National Medical Academy of Postgraduate Education

Department of Anaesthesiology and Intensive Care;

Department of Obstetrics, Gynecology and Reproduction

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


👁 52
⬇ 27
Published
2020-10-29
How to Cite
Pyasetska, N. (2020). THE EFFICACY OF INTRATHECAL DEXAMETHASONE TO PREVENT EARLY COMPLICATIONS OF SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION. Technology Transfer: Innovative Solutions in Medicine, 10-13. https://doi.org/10.21303/2585-663.2020.001470
Section
Medicine and Dentistry