Journal article
High-dose versus low-dose dexamethasone for postoperative analgesia after Caesarean delivery: a randomised, double-blind, two-centre trial
British journal of anaesthesia : BJA, Vol.136(6), pp.1885-1893
06/2026
DOI: 10.1016/j.bja.2026.02.005
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.
Details
- Title: Subtitle
- High-dose versus low-dose dexamethasone for postoperative analgesia after Caesarean delivery: a randomised, double-blind, two-centre trial
- Creators
- Eva Roofthooft - Department of Anaesthesiology, GZA Sint Augustinus Hospital, Antwerp, BelgiumCharlotte De Loecker - Universitair Ziekenhuis LeuvenFried’l D'Hoore - Universitair Ziekenhuis LeuvenRalph Kempenaers - Universitair Ziekenhuis LeuvenSteffen Fieuws - KU LeuvenHenrik Kehlet - Copenhagen University HospitalCynthia A. Wong - University of IowaSteffen Rex - KU LeuvenMarc Van de Velde - KU Leuven
- Resource Type
- Journal article
- Publication Details
- British journal of anaesthesia : BJA, Vol.136(6), pp.1885-1893
- DOI
- 10.1016/j.bja.2026.02.005
- ISSN
- 0007-0912
- eISSN
- 1471-6771
- Publisher
- Elsevier Ltd; London
- Grant note
- Belgian Federal Agency for Medicines and Health Products: 2020-005681-33 Belgian Association of Regional Anaesthesia Departmental funding of the Department of Cardiovascular Sciences, Anaesthesia Department at the KU Leuven, Belgium
The study was registered at the Belgian Federal Agency for Medicines and Health Products (EudraCT 2020-005681-33). The study was, in part, supported by a research grant from the Belgian Association of Regional Anaesthesia and by departmental funding of the Department of Cardiovascular Sciences, Anaesthesia Department at the KU Leuven, Belgium. We thank C. Huyghens, Claire Evers and the midwives of the department of Leuven and St Augustinus Antwerp for their contribution to the study.
- Language
- English
- Electronic publication date
- 04/2026
- Date published
- 06/2026
- Academic Unit
- Anesthesia
- Record Identifier
- 9985153359302771
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