Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial.

OBJECTIVE: To compare the effect of local infiltration and intravenous dexamethasone on postoperative pain and recovery after Cesarean Section (CS).

MATERIAL AND METHODS: A Prospective, randomized study conducted on 120 pregnant women attending the labor wards. All participants were scheduled for elective CS under spinal anaesthesia and were randomly divided into 3 equal groups. Group 1 received 16 mg Dexamethasone IV drip. Group II received 16 mg Dexamethasone subcutaneous injection around the caesarean section scar after skin closure and Group III received Placebo (500 cc saline infusion). All cases were followed up for 48 h for assessment of level of pain by using a 10-cm visual analog scale (VAS). Primary outcome parameters were VAS score and the need for additional analgesics. Other parameters were hemodynamic changes and occurrence of side effects or complications.

RESULTS: there was a highly statistically significant difference between placebo and local infiltration groups and between the placebo and IV groups regarding the needs for postoperative morphine. Comparing both interventional groups revealed statistically significant difference between local infiltration and IV groups regarding the needs for postoperative morphine.

CONCLUSION: Local infiltration of dexamethasone is more effective than systemic administration to decrease postoperative pain with weaker antiemetic effect. NCT02784340.