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High-dose versus low-dose dexamethasone for postoperative analgesia after Caesarean delivery: a randomised, double-blind, two-centre trial
Journal article   Peer reviewed

High-dose versus low-dose dexamethasone for postoperative analgesia after Caesarean delivery: a randomised, double-blind, two-centre trial

Eva Roofthooft, Charlotte De Loecker, Fried’l D'Hoore, Ralph Kempenaers, Steffen Fieuws, Henrik Kehlet, Cynthia A. Wong, Steffen Rex and Marc Van de Velde
British journal of anaesthesia : BJA
04/2026
DOI: 10.1016/j.bja.2026.02.005

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Abstract

Caesarean delivery constitutes major surgery causing moderate to severe pain, so strategies to reduce postoperative pain are needed. High-dose dexamethasone improves perioperative analgesia in non-obstetric patients. We hypothesised that high-dose dexamethasone improves analgesia and recovery after Caesarean delivery. We randomised women having elective Caesarean delivery to receive high-dose (25 mg after birth and 24 h later) or low-dose i.v. dexamethasone (5 mg after birth and placebo 24 h later) dexamethasone i.v. The primary outcome was mean hourly NRS score for pain on movement between 4h and 48 h after surgery. The key secondary outcome was hourly pain score at rest. Other secondary outcomes included maximum pain score, pain score >4, rescue analgesia, opioid consumption, functional recovery, breastfeeding, patient satisfaction, and obstetric and neonatal outcomes. We randomised 210 women (105 per group). Pain on movement was lower in the high-dose than the low-dose group: mean hourly pain score 2.7 (sd 1.1) vs 3.1 (1.2), mean difference –0.47, 95% CI –0.77 to –0.17). Pain at rest was also lower: mean hourly pain score 1.3 (1.0) vs 1.7 (1.0), mean difference –0.35, 95% CI –0.60 to –0.10). All other pain scores, rescue analgesia, opioid consumption, and functional recovery scores were improved in the high-dose group. Adverse effects were similar between groups. High-dose dexamethasone improved analgesia and functional recovery compared with low-dose dexamethasone. The improvements were small, and clinical relevance is questionable. Currently, we do not recommend routine use of high-dose dexamethasone for analgesia following Caesarean delivery.
 Caesarean delivery dexamethasone enhanced recovery postoperative analgesia

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