Abstract
Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 (Control) patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer. Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group (P<0.0001). The mean duration of postoperative analgesia was 336.8±86 min in Intrathecal group and 312.4±106 min in Intravenous group compared with 245.4±93 min in control group (P =0.001). Visual analogue scale scores were significantly less at 4 hours (P<0.0001) and 6 hours (P<0.0001) after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group (P = 0.001); However visual analogue scale was not different at 12 and 24 hours after surgery between groups (p > 0.05). Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.
Highlights
Inadequate postoperative pain relief after cesarean section can increase health-care costs, delay mother child bonding, increase duration of the hospital stay and reduce patient satisfaction
Multimodal approaches to postoperative analgesia, with use of Intrathecal & intravenous betamethasone for post-operative pain different drugs acting via different routes have led to minimal side-effects and good analgesia in the treatment of postoperative pain.[3]
No statistically significant differences were observed in heart rate and mean arterial blood pressure between the three groups, both preoperatively as well as intraoperatively
Summary
Inadequate postoperative pain relief after cesarean section can increase health-care costs, delay mother child bonding, increase duration of the hospital stay and reduce patient satisfaction. It can delay recovery because persistent pain perception can have a negative effect on homeostasis and healing, this is why early treatment of pain with analgesics is important.[1,2]. Several investigators have shown steroids analgesic effects This effect of steroids is caused by inhibition of arachidonic acid that release from damaged cells. Different methods of steroids administration are parentral, local infiltration at operated site, as an adjuvant in nerve blocks, and central-neuraxial blockade.[3,5,6,7]
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