Document Type : Original Article

Authors

1 Department of Medical‑Surgical Nursing, School of Nasibeh Nursing and Midwifery, Mazandaran University of Medical Sciences, Educational Instructor of Nasibeh Nursing and Midwifery School, Sari, Mazandaran, Iran

2 Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran

Abstract

BACKGROUND: Pain and nausea and vomiting are of serious complications following the use of
opiates after surgery, especially cesarean section. Control of postoperative complications is one of
the necessities of quality promotion of health‑care system. Medications with few side effects such
as corticosteroids including dexamethasone can be an appropriate option. In addition, the route of
administration can have a significant effect on the effectiveness of the drug. The aim of the present
study was to compare the effects of intrathecal with intravenous dexamethasone in reducing the
complications associated with intrathecal morphine after cesarean section.
MATERIALS AND METHODS: The study was a double‑blind randomized controlled clinical trial and
determined the effect of intrathecal and intravenous dexamethasone on the incidence and severity
of complications of intrathecal morphine after cesarean section on 120 patients and its relationship
with serious complications after surgery. Descriptive and analytical statistics were used to examine
the characteristics of the case and control groups, and STATA SPSS software was used to compare
the two groups.
RESULTS: There was no significant association between the two groups in terms of baseline
characteristics. Pain score in the intrathecal injection group was lower than the intravenous injection
group, with a statistically significant difference (P = 0.02). In addition, there was a significant
association regarding to the incidence of nausea, vomiting, and itching between intrathecal and
intravenous injection groups (P = 0.008).
CONCLUSION: Dexamethasone was effective to reduce opiate complications after cesarean section.
Establishing a suitable association between dexamethasone half‑life, efficacy, type of use, and time
of use can result the best outcomes and promote patients’ satisfaction in cesarean section.

Keywords

1. Bowring J, Fraser N, Vause S, Heazell AE. Is regional anaesthesia
better than general anaesthesia for caesarean section? J Obstet
Gynaecol 2006;26:433‑4.
2. Jenkins JG, Khan MM. Anaesthesia for Caesarean section:
A survey in a UK region from 1992 to 2002. Anaesthesia
2003;58:1114‑8.
3. Brown DL. Spinal, epidural and caudal anesthesia. In: Miller RD,
editor. Anesthesia. 7th ed. Philadelphia: Churchill Livingstone;
2010. p. 1611‑38.
4. Liu K, Hsu CC, Chia YY. Effect of dexamethasone on
post‑operative emesis and pain. Br J Anesthesia 1998;80:85‑6.
5. Carrol NV, Miederhoff P, Cox FM. Post‑operative nausea and
vomiting after discharge from Out‑patient surgery centers. Anesth
Analg 1995;80:903‑8.
6. Change F, Chan VW. Recovery pattern and home‑readiness after
ambulatory surgery. Anesth Analg 1995;80:896‑902.
7. Rabery PG, Smith G. Anesthesia factors contributing to
post‑operative nausea and vomiting. Br J Anesth 1992;69 Suppl
I: 40S‑5.
8. Mehernoor F, Watcha F, Paul FW. Post‑operative nausea and
vomiting. Anesthesiology 1992;77:162‑84.
9. Hermans V, De Pooter F, De Groote F, De Hert S, Van der Linden P.
Effect of dexamethasone on nausea, vomiting, and pain in
paediatric tonsillectomy. Br J Anaesth 2012;109:427‑31.
10. AllenTK, Jones CA, HabibAS. Dexamethasone for the prophylaxis
of postoperative nausea and vomiting associated with neuraxial
morphine administration: A systematic review and meta‑analysis.
Anesth Analg 2012;114:813‑22.
11. Ho CM, Wu HL, Ho ST, Wang JJ. Dexamethasone prevents
postoperative nausea and vomiting: benefit versus risk. Acta
Anaesthesiol Taiwan 2011;49:100‑4.
12. Jo YY, Lee JW, Shim JK, Lee WK, Choi YS. Ramosetron,
dexamethasone, and their combination for the prevention of
postoperative nausea and vomiting in women undergoing
laparoscopic cholecystectomy. Surg Endosc 2012;26:2306‑11.
13. Kafle SK. Intrathecal meperdine for elective caesarean section:
Acomparison with lidocaine. Can J Anaesth 1993;40:719‑21.
14. Fujii Y. Retraction notice: Current review of ramosetron in the
prevention of postoperative nausea and vomiting. Curr Drug Saf
2011;6:122‑7.
15. Romain A, Lefebvre Jan L, Willems Marc G. Gastric relaxation
and vomiting by apomorphine, morphine and fentanyl in the
conscious dog. Eur J Pharmacol 1981;69:139‑45.
16. Stan T, Goodman EJ, Bravo‑Fernandez C and Holbrook CR.
Adding methylprednisolone to local anesthetic increases the
duration of axillary block. Reg Anesth Pain Med 2004;29:380‑1.
17. Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea
and vomiting in regional anesthesia: A review. Anesthesiology
2003;98:530‑47.
18. Mohammadpour S, Niknam N, Javan‑Noughabi J, Yousefi M,
Ebrahimipour H, Haghighi H, et al. The factors associated with
direct medical costs in gastric cancer patients: Quintile regression
approach compared with gamma regression. Value Health Reg
Issues 2020;21:127‑32.
19. Thomas W, Freeley A, Macaxio A: The post‑anesthesia care
unit. In: Miller RD, editor. Anesthesia. 5th ed. Philadelphia, USA:
Churchill Livingstone; 2000. p. 2316‑8.
20. Aldrete JA. The post anesthesia recovery score revisited.
J Clin Anesth 1995;7:89‑91. Robent K, Stoeling A, Miller RD.
Post‑aneasthesia care unit. In: Miller RD, editor. Basics of
Anesthesia. 4th ed. Philadelphia, USA: Churchill Livingstone;
2000. p. 409‑10.
21. Wang JJ, Ho ST, Uen YH, Lin MT, Chen KT, Huang JC, et al.
Small‑dose dexamethasone reduces nausea and vomiting after
laparoscopic cholecystectomy: A comparison of tropisetron with
saline. Anesth Analg 2002;95:229‑32.
22. Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces
pain and swelling following extraction of third molar teeth.
Anaesthesia 1993;48:961‑4.
23. Henzi I, Walder B, Tramer MR. Dexamethasone for the
prevention of post‑operative nausea and vomiting. Anesth Analg
2000;90:186‑94.
24. Tzeng JI, Hsing CH, Chu CC, Chen YH, Wang JJ. Low dose dexamethasone reduces nausea and vomiting after epidural
morphine: A comparison of metoclopramide with saline. J Clin
Anesth 2002;14:19‑23.
25. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S,
et al. Volatile anaesthetics may be the main cause of early but not
delayed postoperative vomiting: A randomized controlled trial
of factorial design. Br J Anaesth 2002;88:659‑68.
26. Ready LB. acute peerioprative pain. In: Miller RD, editor.
Anesthesia. 5th ed. Philadelphia: Churchila Livingston; 2000.
p. 2323‑50.
27. Chyhan A, Ustum H, Altunatmaz I.Unal N. Is Metoclopramide
an alternative to tramadol in manegment of post operativepain?
An experimental study. J Vet Med A Physiol Pathol Clin Med
2005;52:294‑53.
28. Watcha M. White P. Postoperative nausea and vomiting.
Its etiology, treatment and prevention. Anesthesiology
1992;77:162‑84.
29. Pazoki SH. The effectiveness of Metoclopramide infusion on
postoperative pain control in Imam Khomeini hospital (Persian).
Rahavad Danesh 2000;3:6‑10.
30. Italian Group for Antiemetic Research. Dexamethasone,
granisetron, or both for the prevention of nausea and vomiting
during chemotherapy for cancer. N Engl J Med 1995;332:1‑5.
31. Coloma M, White PF, Tongir WK. Dexamethasone facilitates
discharge after out‑patient anorectal surgery. Anesth Analg
2001;92:85‑8.
32. McKenzie R, Tantisira B, Karambelkar DJ, Riley TJ, Abdelhady H.
Comparison of ondansetron with ondansetron plus dexamethasone
in the prevention of postoperative nausea and vomiting. Anesth
Analg 1994;79:961‑4.
33. Routhenberg DM, Peng CC, Normoyle DA. Dexamethasone
minimizes postoperative nausea and vomiting in out patients
Anesth Analg 1996;82:S388.
34. Splinter WM, Roberts DJ. Dexamethasone decreases vomiting by
children after tonsillectomy. Anesth Analg 1996;83:913‑6.
35. Wang JJ, Ho ST, Liu YH, Ho CM, Liu K, Chia YY. Dexamethasone
decreases epidural morphine‑related nausea and vomiting. Int
Anesth Res Soc 1999;89:117‑20.
36. CooperIM. Morphine for postoperative analgesia. A comparison
of intramuscular and subcutaneous routes of administration.
Anaesth Intensive Care 1996;24:574‑8.
37. Shahraz S, Ghazikhani T. Iran Drug (Persian).1st ed. Tehran:
Taymorzade Publication; 2002. p. 216.
38. Terrence KA, Cheryl A, Ashraf S. Dexamethasone for the
prophylaxis of postoperative nausea and vomiting associated
with neuraxial morphine administration: A systematic review
and meta‑analysis. Int Anesth Res Soc 2012;114:318‑22.
39. Hunt L, Luck AJ, Rudkin G. Day‑case hemorrhoidectomy. Br J
Surg 1999;86:225‑8.
40. Szilvia S, Ramesh SC, Dominic CH, John O, Damian M,
George DS. A comparison of dexamethasone, ondansetron and
dexamethasone plus ondansetron as prophylactic 13 antiemetic
and antipruritic therapy in patients receiving intrathecal
morphine for major orthopedic surgery. Int Anesth Res Soc
2003;97:259‑63.
41. Banihashem N, Hassannasab B, Naziri F, Rahimifar AR,
Hosseini V, Shirkhani Z. Comparison of the prophylactic effect
of ondansetron and dexamethasone on postoperative nausea and
vomiting after intrathecal meperidine in women scheduled for
elective cesarean section. J Babol Univ Med Sci 2010;13:29‑33.
42. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F,
Akbarian‑Tefaghi N. The effect of intravenous administration of
dexamethasone on postoperative pain, nausea, and vomiting after
intrathecal injection of meperidine. Anesth Analg 2007;104:987‑9.
43. Tzeng JI, Wang JJ, Ho ST, Tang CS, LiuYC, Lee SC. Dexamethasone
for prophylaxis of nausea and vomiting after epidural morphine
for post‑Caesarean section analgesia: comparison of droperidol
and saline. Br J Anaesth 2000;85:865‑8.
44. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative
nausea and vomiting after spinal morphine for cesarean section.
Comparision of cyclizine, dexamethasone and placebo. Br J
Anesth 2003;90:665‑70.
45. Wu JI, LoY, ChiaYY, Liu K, FongWP, Yang LC, et al. Prevention of
postoperative nausea and vomiting after intrathecal morphine for
cesarean section: A randomized comparison of dexamethasone,
droperidol, and a combination. Int J Obstet Anesth 2007;16:122‑7.
46. Szarvas S, Chellapuri RS, Harmon DC, Owens J, Murphy D,
Shorten GD. A comparison of dexamethesone, ondansetron and
dexamethasone plus ondansetron as prophylactic antiemetic and
antipruritic therapy in patients receiving intrathecal morphine for
major orthopedic surgery. Anesth Analg 2003;97:259‑63.
47. Pervaiz Kazemi A, Kamali Pour H, Mohammadi S. Effect of single
dose of dexamethasone on nausea, vomiting and discharge time
from recovery room in out‑patients undergoing anorectal surgery.
J Med Res 2003;41:34‑40.
48. Olstad OA, Skjelbred P. Comparison of the analgesic effect of a
corticosteroid and paracetamol in patients with pain after oral
surgery. Br J Clin Pharmacol 1986;22:437‑42.