Postoperative Analgesic Effects of Intravenous Dexamethasone for Patients Undergoing Cesarean Delivery under Spinal Anesthesia at Dilla University Referral Hospital, Ethiopia, 2021: A randomized Controlled Trial.

                              Abstract Background: The use of cesarean sections worldwide has increased to unprecedented levels. In Ethiopia, the cesarean section delivery rate is above the rate recommended by the WHO. The postoperative pain experience is moderate to severe in most patients during their postoperative period. Administration of intravenous dexamethasone is thought to have an analgesic effect after surgery even though the analgesic profile of preoperatively administered dexamethasone is less addressed. Objective: - This study aimed to assess the postoperative analgesic effect of preoperative intravenous dexamethasone for patients undergoing cesarean delivery under spinal anesthesia at Dilla University Referral Hospital, Southern Ethiopia. Methodology: - A double-blinded RCT was done on 112 patients undergoing elective cesarean section under spinal Anesthesia that have been allocated randomly into normal saline and dexamethasone groups. A total analgesic consumption, time to first analgesic request and postoperative pain score with NRS were followed for 24hr in both groups. Shapiro wilk’s were used to check normality. Independent samples t-test was used for comparison of means between groups, Mann Whitney U test for non-normally distributed data and chi-square for categorical variables and P-value < 0.05 was considered statistically significant with a power of 80%. Result:- The finding of this study showed that the postoperative pain score of the dexamethasone group was significantly lower than the normal saline group @2hr, @4hr, @6hr, @12hr, @18hr and @24hr with a statically significant p-value<0.05. There was also significant difference in the time to the first rescue analgesic request time between the two group; with dexamethasone group (Median=347.5min) and the Normal saline (Median=230min) with p=0.001. The total consumption of tramadol and diclofenac were higher in normal saline as compared to the dexamethasone group (p <0.05). The proportion of PONV is higher in normal saline group but there was no statistically significant difference between the two groups Conclusion and recommendation:-We conclude that preoperative administration of 8mg dexamethasone prolongs the first analgesic request time, decrease postoperative tramadol and diclofenac consumption and decreases postoperative pain score. We recommend to researchers to do further RCT with a different dose of dexamethasone and in a multicenter basis