静脉给药地塞米松治疗剖宫产后疼痛的有效性和安全性：对现有文献的系统回顾和荟萃分析

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-05-12 DOI:10.1016/j.ijoa.2025.104682

Dimitrios Ioannopoulos , Zoi Tsani , Eleni Chatsiou , Eleni Arnaoutoglou , Georgia Tsaousi

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引用次数: 0

摘要

剖宫产引起的手术组织创伤是启动伤害感受器激活的关键刺激，导致严重的术后疼痛。地塞米松似乎可以减轻疼痛引起的炎症反应，并可能作为剖宫产后的镇痛辅助药物。本系统综述和荟萃分析旨在评估静脉注射地塞米松对剖宫产后疼痛管理的作用。方法检索PubMed、Scopus、CENTRAL和公共科学图书馆的电子数据库，筛选所有与静脉注射地塞米松与安慰剂在剖宫产镇痛效果相关的随机对照试验（rct）。在符合条件的试验中，分别使用ROB2工具和GRADE方法评估偏倚风险和证据确定性。结果定性分析纳入17项rct，定量分析纳入15项rct。静脉注射地塞米松与首次要求抢救镇痛的时间延长相关(平均差[MD] 3.33小时，95% CI 1.67 ~ 4.99；I2 = 92.7%)，阿片类镇痛药用量较低(MD,−3.23 mg；95% CI,−4.04 ~−2.41；I2 = 67.5%)，与安慰剂相比，术后24小时疼痛评分改善，但预测间隔未能证实这些有利效果。静脉注射地塞米松可降低术后恶心和呕吐的风险，但不能降低瘙痒的风险。结论围术期静脉地塞米松似乎是一种很有希望的辅助治疗剖宫产镇痛方式，延长了首次要求抢救镇痛的时间，减少了镇痛消耗，降低了术后24小时休息时的疼痛评分。然而，现有证据的巨大异质性和低确定性使我们无法得出任何明确的结论。

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Efficacy and safety of intravenous administration of dexamethasone on post-cesarean delivery pain: a systematic review and meta-analysis of current literature

Background

Surgical tissue trauma induced by cesarean delivery serves as a pivotal stimulus for initiating the activation of nociceptors, leading to severe postoperative pain. Dexamethasone seems to mitigate pain-elicited inflammatory response and potentially serve as an analgesic adjunct in the post-cesarean period. This systematic review and meta-analysis aimed to assess the administration of intravenous dexamethasone for post-cesarean pain management.

Methods

An electronic database search involving PubMed, Scopus, CENTRAL, and the Public Library of Science was conducted to identify all randomized controlled trials (RCTs) pertinent to the analgesic efficacy of intravenous dexamethasone compared with placebo for cesarean delivery. The risk of bias and certainty of evidence in eligible trials were assessed using the ROB2 tool and the GRADE approach, respectively.

Results

Seventeen RCTs were included in the qualitative analysis, and 15 in the quantitative analysis. Intravenous dexamethasone was associated with prolonged time to first request for rescue analgesia (mean difference [MD] 3.33 hours, 95% CI 1.67 to 4.99; I² = 92.7%), lower opioid analgesic consumption (MD, −3.23 mg; 95% CI, −4.04 to −2.41; I² = 67.5%) within 24 hours and improved pain scores up to 24 hours postoperatively compared with placebo, however prediction intervals failed to confirm these favorable effects. The risk of postoperative nausea and vomiting was reduced with intravenous dexamethasone, but not that of pruritus.

Conclusions

Intravenous perioperative dexamethasone seems to be a promising adjunct to established analgesic modalities in cesarean delivery, with prolonged time to first request for rescue analgesia, reduced analgesic consumption, and reduced pain scores at rest up to 24 hours postoperatively. However, the substantial heterogeneity and low certainty of available evidence preclude any definite conclusions from being drawn.

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.