Dexamethasone for Post-operative Pain After Cesarean Delivery Under Neuraxial Anesthesia.

NCT ID: NCT07257406

Last Updated: 2026-01-08

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 87 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-13
• Study Completion Date: 2025-10-01

Brief Summary

After surgery pain in women who have had a cesarean delivery is a determining factor in the quality and duration of their hospital stay. Insufficient pain relief can lead to longer hospitalization and long term pain, which can result in long term use of pain medication. A classic method to alleviate pain after cesarean delivery is by injecting morphine into the spinal fluid, in the women's back, in addition to prescribing morphine by mouth as needed after the surgery. However, the negative effects associated with morphine and morphine-like drugs, limit the doses used, their pain relief capacity, and can negatively affect the after surgical experience of women. An approach which uses pain relief that acts on different pain pathways to treat after surgery pain helps limit the negative effects of different drugs. The potential benefit of dexamethasone as pain relief in women who have had a cesarean delivery is all the more interesting because of its minimal negative effects compared to morphine-like drugs. Its low cost, its effectiveness to prevent nausea, and its impact on the general condition of patients make dexamethasone even more attractive.

Detailed Description

Postoperative pain in patients who have undergone a cesarean delivery is a determining factor in the quality and duration of their hospital stay. Suboptimal analgesia can lead to prolonged hospitalization and chronic pain, which can result in chronic use of pain medication. Treatment of post-operative pain after cesarean delivery uses intrathecal morphine, and the use of opioids as needed post-operatively. However, the side effects associated with opioids limit the doses used, their analgesic efficacy, and adversely affect the postoperative experience of patients. The multimodal approach to postoperative pain allows for analgesia that acts on different pain mechanisms while limiting the adverse effects of different drugs. The potential benefits of dexamethasone as a co-analgesic in women who have had a cesarean section are all the more interesting because of its minimal adverse effects compared to opioids. Its low cost, its effectiveness as antiemetic prophylaxis, and its impact on the general condition of patients make dexamethasone even more attractive.

In this randomised controlled trial, 100 patients are to be recruited and randomised to one of two groups. Both groups will receive standard treatment. In addition to standard treatment, the first group will receive dexamethasone 8 mg IV after umbilical cord clamping and the other group will receive a placebo.

The patients will be followed for 24 hours post-operatively. Their pain levels at rest and during movement will be recorded on an 11 point pain scale. The dose of hydromorphone used in the first 24 hours will be recorded. The patients are also asked to complete the QOR-40 questionnaire, which aims to assess the quality of their postoperative recovery. The primary outcome is the pain on an 11 point scale at the first rise 6 hours post-operatively.

The investigators hypothesize that dexamethasone will improve pain scores and diminish opioid use in the first 24 hours post-operatively.

Conditions

Pregnancy; Cesarean Delivery; Dexamethasone

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: QUADRUPLE

Study Groups

Dexamethasone

Group Type: ACTIVE_COMPARATOR

Dexamethasone (IV)

Intervention Type: DRUG

Dexamethasone 8 mg IV will be given 5 minutes after cord clamping in the interventional arm.

Placebo

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

This arm will receive 2 ml of saline 5 min after cord clamping.

Interventions

Dexamethasone (IV)

Dexamethasone 8 mg IV will be given 5 minutes after cord clamping in the interventional arm.

Intervention Type: DRUG

Placebo

This arm will receive 2 ml of saline 5 min after cord clamping.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Age ≥ 18 years
• Cesarean delivery
• Planned spinal or combined neuraxial anesthesia
• Presence of an investigator in the delivery room
• Pregnancy > 34 weeks gestation

Exclusion Criteria

• Cesarean delivery under general anesthesia
• Inability to understand French or English
• Allergy or hypersensitivity to dexamethasone
• Allergy to hydromorphone
• Allergy to NSAIDs
• Acute kidney injury or chronic kidney failure
• Preeclampsia
• Extremely urgent cesarean section
• Urgent cesarean section with non-reassuring fetal monitoring
• Known maternal heart disease
• High-grade placental abnormality
• Diabetes (pregnancy or pre-existing)
• Systemic infection, sepsis, fever
• Regular use of dexamethasone in the last year
• Weight greater than 120 kg and less than 70 kg
• Height less than 150 cm
• Chronic pain and/or chronic use of opioids

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Université de Montréal

OTHER

Sponsor Role: collaborator

Valerie Zaphiratos

OTHER

Sponsor Role: lead

Responsible Party

Valerie Zaphiratos

Associate Professor of Anesthesiology

Responsibility Role: SPONSOR_INVESTIGATOR

Locations

CHU Sainte-Justine

Montreal, Quebec, Canada

Countries

Canada

References

Mohtadi A, Nesioonpour S, Salari A, Akhondzadeh R, Masood Rad B, Aslani SM. The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy. Anesth Pain Med. 2014 Aug 13;4(3):e17872. doi: 10.5812/aapm.17872. eCollection 2014 Aug.

Reference Type: BACKGROUND

PMID: 25237639 (View on PubMed)

Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. J Res Pharm Pract. 2013 Jul;2(3):99-104. doi: 10.4103/2279-042X.122370.

Reference Type: BACKGROUND

PMID: 24991614 (View on PubMed)

Cardoso MM, Leite AO, Santos EA, Gozzani JL, Mathias LA. Effect of dexamethasone on prevention of postoperative nausea, vomiting and pain after caesarean section: a randomised, placebo-controlled, double-blind trial. Eur J Anaesthesiol. 2013 Mar;30(3):102-5. doi: 10.1097/EJA.0b013e328356676b.

Reference Type: BACKGROUND

PMID: 23022704 (View on PubMed)

Other Identifiers

2019-1840

Identifier Type: -

Identifier Source: org_study_id