Comparison between intrathecal and intravenous betamethasone for post-operative pain following cesarean section: a randomized clinical trial

Objective: Inadequate postoperative pain relief after cesarean section can increase complications. In this study, we evaluated the effect of intrathecal betamethasone as an adjunct to bupivacaine on postoperative pain in patients undergoing cesarean section. Methodology: Ninety-nine patients undergoing cesarean section were assigned to one of three groups. Group 1 (Control) patients received intrathecal bupivacaine, Group 2 patients received intrathecal bupivacaine plus preservative free betamethasone and Group 3 patients received betamethasone intravenously with intrathecal bupivacaine. After surgery, diclofenac in suppository form was administered as needed for analgesia. Postoperative diclofenac requirements, time to first analgesic administration and visual analogue scale pain scores were recorded by a blinded observer. Results: Supplemental analgesic dose requirement with diclofenac for the first 24 hours were significantly less in both groups that received betamethasone compared to the control group (P <0.0001). The mean duration of postoperative analgesia was 336.8±86 min in Intrathecal group and 312.4±106 min in Intravenous group compared with 245.4±93 min in control group (P =0.001). Visual analogue scale scores were significantly less at 4 hours (P<0.0001) and 6 hours (P<0.0001) after surgery in groups that received betamethasone in comparison to control group. The pain scores at 6 hours after surgery were higher in the Intravenous group compared with the Intrathecal group (P = 0.001); However visual analogue scale was not different at 12 and 24 hours after surgery between groups (p > 0.05). Conclusion: Intrathecal betamethasone reduced pain and decreased the required dose of diclofenac in 24 hours after cesarean section.