Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized, double-blinded, placebo controlled clinical trial - 22/11/17
: Professor, Jasveer Singh, M.D. a : Associate Professor, Richa Saroa, M.D. a : Associate Professor, Reeti Mehra, M.D. b : Associate ProfessorAbstract |
Objective |
To study the role of intravenous (i.v.) dexamethasone as an analgesic adjunct in labor analgesia.
Design |
Double-blinded randomized controlled trial.
Setting |
Labor analgesia in a tertiary-care teaching hospital.
Patients |
Eighty consenting ASA I-II parturients, age>18year, nulliparous, single gestation, cephalic presentation at ≥36 wk. of gestation, in early spontaneous labor (cervical dilatation≤5cm) requesting epidural analgesia.
Interventions |
The patients were randomized to two groups. The Dexa group received 8mg of dexamethasone i.v. in 50ml normal saline approximately 45min before the procedure. Placebo group patients received 50ml normal saline only. All patients underwent epidural labor analgesia per hospital protocol. After an initial bolus, they received continuous background infusion of 5ml/h of 0.1% of levobupivacaine with 2μg/ml of fentanyl, with the provision of patient controlled boluses of 5ml of the same drug combination with a lockout interval of 12min if needed.
Measurements |
Primary outcome measure: hourly average consumption of neuraxially administered levobupivacaine-fentanyl combination. Secondary outcomes and observations: pain score, maternal satisfaction, sensory and motor block characteristics, hemodynamic parameters of mother, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores at 1 and 5min, and adverse effects.
Main results |
Average hourly drug consumption was significantly lower in Dexa group as compared to Placebo group (10.34±1.79ml/h vs. 11.34±1.83ml/h; mean difference 1.007, 95% CI 0.199–1.815; P=0.015). The median number of bolus doses was 4 (interquartile-range [IQR] 3–5.75) and 5 (IQR 3–6) in the Dexa and Placebo groups, respectively (P=0.162). There was no significant difference between groups with regard to pain scores, maternal satisfaction and hemodynamics, mode of delivery, and adverse effects.
Conclusions |
I.v. dexamethasone significantly decreased hourly average drug consumption of levobupivacaine-fentanyl combination through the epidural route, demonstrating the epidural drug dose sparing effect during labor analgesia.
Le texte complet de cet article est disponible en PDF.Highlights |
• | We studied the role of intravenous dexamethasone as an analgesic adjunct in epidural labor analgesia. |
• | Eighty laboring parturients were randomly assigned to either the dexamethasone group or placebo group. |
• | The primary outcome measure was the hourly consumption of neuraxially administered levobupivacaine-fentanyl combination. |
• | Average hourly drug consumption was significantly lower in dexamethasone group as compared to placebo group. |
• | Intravenous dexamethasone should be considered as an adjunct to improve analgesia in patients undergoing labor. |
Keywords : Dexamethasone, Intravenous, Labor analgesia, Epidural, Levobupivacaine, Fentanyl
Plan
| ☆ | Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. |
Vol 43
P. 6-10 - décembre 2017 Retour au numéro
Article précédent
- Dexamethasone: The wonder drug in perioperative medicine
- Gildasio S. De Oliveira, Mathew Thran
- Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study
- An Teunkens, Kris Vanhaecht, Kristien Vermeulen, Steffen Fieuws, Marc Van de Velde, Steffen Rex, Luk Bruyneel
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?