Volume 29, Issue 132 (January & February 2021)                   J Adv Med Biomed Res 2021, 29(132): 28-33 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Razavizadeh M R, Rajabi M, Moraveji A, Shafiei Rad E, Mahdian M. The Effect of Intravenous Dexamethasone versus Ketamine on Operative Pain in Patients Undergoing Cesarean Section. J Adv Med Biomed Res 2021; 29 (132) :28-33
URL: http://journal.zums.ac.ir/article-1-6052-en.html
The Effect of Intravenous Dexamethasone versus Ketamine on Operative Pain in Patients Undergoing Cesarean Section
Mohammad Reza Razavizadeh1 , Mehdi Rajabi1 , Alireza Moraveji2 , Ehsan Shafiei Rad1 , Mehrdad Mahdian * 3
1- Dept. of Anesthesiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
2- Dept. of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
3- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran , mmahdian78@gmail.com
Abstract:   (145528 Views)

 Background & Objective:  Patients undergoing a caesarean section (CS) frequently experience shoulder pain, which is often neglected. However, there are some recommendations to prevent or relieve this pain. This study examined the effect of intravenous dexamethasone and ketamine on reducing shoulder pain in patients who underwent a CS under spinal anesthesia.
 Materials & Methods:  The cohort of this prospective study comprised 231 subjects, all of whom were candidates for a CS during 2016. The patients were evaluated based on the type of medication received. After undergoing spinal anesthesia, the first group received 0.5 mg/kg ketamine intravenously and the second group received 0.1 mg/kg dexamethasone intravenously. The patients in these two groups were compared with a control group made up of patients who had not received any medication. Levels of pain severity during and immediately after, as well as 1 h, 6 h, 12 h, 18 h, and 24 h after the CS, were recorded based on the visual analogue scale (VAS). The amount of pethidine consumed was also documented.
 Results:  Compared to the control group, the intravenous administration of ketamine and dexamethasone significantly reduced shoulder pain resulted from CS under spinal anesthesia (P<0.05). In addition, the number of pethidine recipients in the control group was significantly higher (P<0.001).
 Conclusion:  The results showed that prophylactic administration of dexamethasone and ketamine is effective in relieving shoulder pain after a CS.

Keywords: Caesarean section, Spinal anesthesia, Shoulder pain, Dexamethasone, Ketamine
Full-Text [PDF 353 kb]   (154135 Downloads) |   |   Full-Text (HTML)  (2409 Views)  

✅ The results showed that prophylactic administration of dexamethasone and ketamine is effective in relieving shoulder pain after a CS.


Type of Study: Original Article | Subject: Clinical medicine
Received: 2020/06/8 | Accepted: 2020/10/16 | Published: 2020/11/14
References
1. Tappauf C, Schest E, Reif P, Lang U, Tamussino K, Schoell W. Extraperitoneal versus transperitoneal cesarean section: a prospective randomized comparison of surgical morbidity. Am J Obstet Gynecol 2013;209:338. e1-. e8. [DOI:10.1016/j.ajog.2013.05.057]
2. Torloni MR, Betran AP, Souza JP, et al. Classifications for cesarean section: a systematic review. PloS one 2011;6:e14566. [DOI:10.1371/journal.pone.0014566]
3. Mascarello KC, Horta BL, Silveira MF. Maternal complications and cesarean section without indication: systematic review and meta-analysis. Revista de saude publica 2017;51:105. [DOI:10.11606/S1518-8787.2017051000389]
4. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet. 2011;283:735-41. [DOI:10.1007/s00404-010-1450-0]
5. [5] Kikuchi C, Tonozaki S, Gi E, Watanabe M, Shimizu H. Shoulder-tip pain during cesarean section under combined spinal-epidural anesthesia. Masui JapaneseJ Anesthesiol. 2014;63:149-52.
6. Cift T, Ustunyurt E, Yilmaz C, Olmez F, Basar B. Shoulder tip pain after cesarean section. J Clin Diag Res. 2015;9:QC04. [DOI:10.7860/JCDR/2015/13841.6314]
7. Zirak N, Soltani G, Hafizi L, Mashayekhi Z, Kashani I. Shoulder pain after caesarean section: Comparison between general and spinal anaesthesia. J Obstet Gynaecol. 2012;32:347-9. [DOI:10.3109/01443615.2011.654289]
8. Suginami R, Taniguchi F, Suginami H. Prevention of postlaparoscopic shoulder pain by forced evacuation of residual CO2. J Soc Laparoendoscopic Surg. 2009;13:56.
9. Abbas MS, Askar OA, Aleem AAA. Pre-emptive ketorolac for prevention of intraoperative shoulder pain in patients undergoing cesarean section: A double blind randomized clinical trial. Asian J Anesthesiol. 2017;55:68-72. [DOI:10.1016/j.aja.2017.07.002]
10. Danelli G, Berti M, Casati A, et al. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2% wt/vol ropivacaine. Europ J Anaesthesiol. 2007;24:596-601. [DOI:10.1017/S0265021506002390]
11. Tan N, Agnew NM, Scawn ND, Pennefather SH, Chester M, Russell GN. Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline. Anesthesia & Analgesia 2002;94:199-202. [DOI:10.1213/00000539-200201000-00038]
12. Ventham NT, Kennedy ED, Brady RR, et al. Efficacy of intravenous lidocaine for postoperative analgesia following laparoscopic surgery: a meta-analysis. World J Surg. 2015;39:2220-34. [DOI:10.1007/s00268-015-3105-6]
13. Sjövall S, Kokki M, Kokki H. Laparoscopic surgery: a narrative review of pharmacotherapy in pain management. Drugs 2015;75:1867-89. [DOI:10.1007/s40265-015-0482-y]
14. Donatsky AM, Bjerrum F, Gögenur I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endoscop 2013;27:2275-82. [DOI:10.1007/s00464-012-2759-5]
15. Valadan M, Banifatemi S, Yousefshahi F. Preoperative gabapentin to prevent postoperative shoulder pain after laparoscopic ovarian cystectomy: a randomized clinical trial. Anesthesiol Pain Med. 2015;5: e31524. [DOI:10.5812/aapm.31524]
16. Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Randomized clinical trial: prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg. 2000;87:1161-5. [DOI:10.1046/j.1365-2168.2000.01507.x]
17. Tsai HW, Chen YJ, Ho CM, et al. Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arch Surg. 2011;146:1360-6. [DOI:10.1001/archsurg.2011.597]
18. Asgari Z, Mozafar-Jalali S, Faridi-tazehkand N, Sabet S. Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy. Int J Fertil Steril 2012;6:59.
19. Sutchritpongsa P, Chaipakdi P, Sirimai K, Chalermchokcharoenkit A, Tanmahasamut P. Intraperitoneal sub-diaphragmatic instillation of bupivacaine plus morphine for reducing postoperative shoulder pain after gynecologic endoscopy. J Med Assoc Thailand. 2013;96:513-8.
20. Sleigh J, Harvey M, Voss L, Denny B. Ketamine-more mechanisms of action than just NMDA blockade. Trend Anaesthesia Crit Care. 2014;4:76-81. [DOI:10.1016/j.tacc.2014.03.002]
21. Vyvey M. Steroids as pain relief adjuvants. Canadian Family Physician 2010;56:1295-7.
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Advances in Medical and Biomedical Research

Designed & Developed by : Yektaweb