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Efficacy of intravenous dexamethasone on postoperative pain after caesarean delivery under spinal anaesthesia with an intrathecal long-acting opioid: a systematic review and meta-analysis

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Abstract

Purpose

Intravenous dexamethasone is recommended in elective caesarean delivery to decrease postoperative pain. However, the efficacy of spinal anaesthesia with an intrathecal long-acting opioid such as morphine or diamorphine for caesarean delivery has not been systematically investigated.

Methods

We searched all randomized controlled trials (RCTs) of pregnant women undergoing caesarean delivery under spinal anaesthesia with an intrathecal morphine or diamorphine via MEDLINE, CENTRAL, EMBASE, ICTRP, and ClinicalTrials.gov on May 18, 2022. Primary outcomes were time to first rescue analgesia, consumption of oral morphine equivalents, and incidence of drug-related adverse reactions. We evaluated the risk of bias for each outcome using the Risk of Bias 2. We conducted a meta-analysis using a random effects model. We evaluated the certainty of evidence with the GRADE approach.

Results

Five RCTs (455 patients) were included. The results of intravenous dexamethasone were as follows: time to first rescue analgesia (mean difference [MD] 0.99 h, 95% confidence interval [CI] − 0.86 to 2.84; very low certainty) and consumption of oral morphine equivalents (MD − 6.55 mg, 95% CI − 17.13 to 4.02; moderate certainty). No incidence of drug-related adverse reactions was reported (very low certainty).

Conclusion

The evidence was very uncertain about the efficacy of intravenous dexamethasone on time to first rescue analgesia and the incidence of drug-related adverse reactions. Intravenous dexamethasone probably reduces the consumption of oral morphine equivalents. Anaesthesiologists might want to consider intravenous dexamethasone for postoperative pain after caesarean delivery under spinal anaesthesia with an intrathecal long-acting opioid.

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Data availability

The data generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are grateful to Dr. Unyime S. Ituk (Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa, USA), and Dr. Terrence K. Allen (Department of Anesthesiology, Duke University Medical Center, Durham, USA), the authors of the included studies for providing the detailed information. We are also grateful to Dr. Yuki Kataoka (Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan) for helping to conduct the sensitivity analyses to verify the robustness of the results by seeking informative missingness odds ratios. We would like to thank Editage (http://www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan

    Yuji Kamimura, Tatsuya Tsuji, Yusuke Aoki, Motoshi Tanaka & Kazuya Sobue

  2. Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan

    Yuji Kamimura, Kyosuke Kamijo & Masahiro Banno

  3. Department of Gynecology, Nagano Municipal Hospital, Nagano, Japan

    Kyosuke Kamijo

  4. Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan

    Masahiro Banno

  5. Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Masahiro Banno

  6. Department of Anesthesiology, Toyokawa City Hospital, Toyokawa, Japan

    Hidekazu Ito

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  1. Yuji Kamimura
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  2. Kyosuke Kamijo
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Correspondence to Yuji Kamimura.

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Yuji Kamimura, Kyosuke Kamijo, Masahiro Banno, Tatsuya Tsuji, Yusuke Aoki, Hidekazu Ito, Motoshi Tanaka and Kazuya Sobue have no conflict of interest.

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Kamimura, Y., Kamijo, K., Banno, M. et al. Efficacy of intravenous dexamethasone on postoperative pain after caesarean delivery under spinal anaesthesia with an intrathecal long-acting opioid: a systematic review and meta-analysis. J Anesth 37, 416–425 (2023). https://doi.org/10.1007/s00540-023-03183-7

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  • DOI: https://doi.org/10.1007/s00540-023-03183-7

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