Article Notes
Article pearls, summaries and comments.
- Does peri-operative intravenous dexamethasone reduce pain and opioid consumption after caesarean delivery? YES
- Are the effects statistically significant? YES
- Are the effects clinically significant? Possibly, though pain scores are only modestly improved and the reduction in opioid use is only small.
- Are the findings applicable to my patient population? Possibly, though the majority of studies were performed in Middle East, Asian & South Asian hospitals, and with diverse post-operative analgesic regimes.
- Is peri-operative dexamethasone safe? Probably, though few studies were adequately powered to identify less-common potential side effects, such as infection or delayed wound healing.
- Quality of evidence is low to modest. Notably, the primary outcome for most studies was PONV reduction, not post-operative pain.
- Should this evidence result in routine practice change? Probably not at this stage. IV dexamethasone may however be an appropriate intervention in select patient groups.
Daniel Jolley
Note this is a systemic review of a small number of RCTs published very early in the COVID-19 pandemic, and notably only one of the four RCTs included coronarvirus, Loeb (2009), the others mainly focusing on influenza [MacIntyre (2011), MacIntyre (2013), Radonovich (2019)]. Obviously none of the studies specifically looked at SARS-CoV-2.
Subsequent N95/P2 mask studies since this have shown significant benefit of high-quality masks in reducing COVID-19 transmission.
Daniel Jolley