Women's Health Center, Assiut University, Assiut, Egypt.
Int J Gynaecol Obstet. 2012 Feb;116(2):158-61. doi: 10.1016/j.ijgo.2011.10.002. Epub 2011 Oct 26.
To investigate the effect of intrathecal dexamethasone administered with intrathecal morphine at cesarean delivery on postoperative adverse effects and patient satisfaction.
A triple-blind, randomized, placebo-controlled trial conducted between February 2008 and December 2009 of 120 pregnant women scheduled to undergo cesarean delivery. The patients were randomized into 2 groups: group 1 received 0.2mg of intrathecal morphine plus 8 mg of intrathecal dexamethasone, while group 2 received 0.2mg of intrathecal morphine plus 0.9% saline solution (placebo). The occurrence of postoperative nausea and vomiting (PONV), postoperative itching, number of vomiting attacks, and need for antiemetics were recorded in both groups. Overall patient satisfaction was also recorded.
PONV was 3 times less likely to occur in the dexamethasone group than in the placebo group. When vomiting did occur, the number of attacks was lower in the dexamethasone group (23 vs 87 attacks; OR 0.26, 95% CI, 0.18-0.39). Administration of antiemetics was markedly lower in the dexamethasone group (18 vs 49 shots; OR 0.10, 95% CI, 0.04-0.23) and less postoperative itching was experienced (OR 0.39; 95% CI, 0.19-0.81). The dexamethasone group reported significantly higher mean overall satisfaction scores (77 ± 17 vs 51 ± 22; mean difference 26.00; 95% CI, 18.97-33.03).
Intrathecal administration of dexamethasone with morphine significantly decreased PONV and improved overall patient satisfaction after cesarean delivery.
研究剖宫产时鞘内给予吗啡加地塞米松对术后不良反应和患者满意度的影响。
这是一项 2008 年 2 月至 2009 年 12 月间进行的、采用三盲、随机、安慰剂对照试验，共纳入 120 例择期行剖宫产的孕妇。将患者随机分为 2 组：组 1 接受 0.2mg 鞘内吗啡加 8mg 鞘内地塞米松，组 2 接受 0.2mg 鞘内吗啡加 0.9%生理盐水（安慰剂）。记录两组患者术后恶心呕吐（PONV）、术后瘙痒、呕吐发作次数和需要止吐药的情况。还记录了患者的总体满意度。
地塞米松组 PONV 的发生率比安慰剂组低 3 倍。发生呕吐时，地塞米松组的呕吐发作次数较少（23 次 vs 87 次；OR 0.26，95%CI，0.18-0.39）。地塞米松组止吐药的使用明显减少（18 次 vs 49 次；OR 0.10，95%CI，0.04-0.23），术后瘙痒的发生率较低（OR 0.39；95%CI，0.19-0.81）。地塞米松组患者的总体满意度评分明显较高（77 ± 17 分 vs 51 ± 22 分；平均差值 26.00；95%CI，18.97-33.03）。
剖宫产时鞘内给予吗啡加地塞米松可显著降低 PONV，并提高患者的总体满意度。
