Intravenous Low Dose (4 mg) Dexamethasone as an Adjunct to Epidural Labour Analgesia with 0.125% Ropivacaine in Parturients: A Randomised Controlled Study

Abstract

Introduction: Labour pain is one of the most severe pains, and the mother’s demand is reason enough for the induction of labour analgesia, provided that no contraindications exist. Labour analgesia must be safe for both the mother and the child. Aim: To assess the impact of a low dose (4 mg) of intravenous (IV) dexamethasone used in conjunction with neuraxial labour analgesia with 0.125% Ropivacaine. Materials and Methods: The present study was a doubleblinded randomised controlled study conducted at tertiary care hospital on 80 parturients classified as American Society of Anaesthesiologists (ASA) II. The parturients were over 18 years old, in their third trimester, carrying a single live foetus that was cephalic at 36 weeks of gestation, and whose cervical dilation was greater than 3 cm and who requested epidural analgesia. All parturients were randomly divided into two equal groups. Before receiving epidural analgesia, the dexamethasone group received 4 mg of IV dexamethasone in 50 mL of normal saline. Patients in the control group received only 50 mL of normal saline. After an initial bolus of 0.125% ropivacaine (8 mL given gradually over 5 minutes), all expectant mothers received a continuous background infusion of 0.125% ropivacaine at a rate of 5 mL/h, along with patient-controlled boluses of 5 mL of the same medication given with a lockout interval of 12 minutes using a Patient Controlled Epidural labour Analgesia (PCEA) pump through the epidural route. Yates continuity correction test (Chi-square test), Fisher’s exact test, and Fisher Freeman Halton were used to compare qualitative data. For categorical data, numbers and percentages were used to summarise all continuous variables as mean±SD. Results: Demographics such as age, height, weight, and preprocedure obstetric-related details were comparable in both groups. There was no statistically significant difference in the average hourly medication intake between the dexamethasone group and the control group (Group D-7.64±0.88 mL/hr and Group C-8.04±1.24 mL/hr, p-value=0.09). Other factors, including pain scores, haemodynamics, administration method, and side effects, did not differ significantly between the two groups. Conclusion: Despite having modest analgesic properties, IV dexamethasone could not significantly reduce the hourly average medication consumption of ropivacaine during epidural labour analgesia.

Keywords

• haemodynamics
• pain
• trimester