Dexamethasone for prevention of spinal hypotension during caesarean delivery: a randomised controlled trial

Spinal anaesthesia is commonly associated with maternal hypotension, which can be deleterious to mother and fetus. Dexamethasone increases peripheral vascular resistance and may be effective in preventing spinal hypotension. We hypothesized that a single preoperative dose of intravenous dexamethasone will prevent spinal hypotension in women undergoing elective caesarean delivery.

A total of 170 participants planned for elective caesarean delivery were randomised to receive a single preoperative intravenous dose of dexamethasone 8 mg (Group D, n=85) or normal saline (Group C, n=85). Following spinal anaesthesia, blood pressure and heart rate were recorded every 1 minute up to 20 minutes and every 5 minutes thereafter. The primary outcome was the incidence of spinal hypotension. The secondary outcomes were maternal blood pressure, phenylephrine requirement, the incidence of post-delivery hypotension, nausea and/or vomiting, shivering, maternal bradycardia, and neonatal outcomes.

The incidence of spinal hypotension was significantly lower in group D (18.8%) compared to group C (38.8%) [difference 20% (95%CI 6.72, 33.28)] (P=0.007). The incidence of post-delivery hypotension and maternal bradycardia were not different between the groups. Phenylephrine requirement, the incidence of nausea and/or vomiting and shivering were significantly less in Group D (all P <0.05). There was no significant difference among the study groups in maternal random blood sugar, neonatal Apgar scores, and umbilical arterial pH.

A single preoperative intravenous dose of dexamethasone 8 mg significantly reduced the incidence of spinal hypotension in patients undergoing caesarean delivery.