Dose-Response Effects of Intravenous Dexamethasone as an Adjunct to Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial.
- 1Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China.
- 2Department of Anesthesiology, The Second People's Hospital of Wuhu, Wuhu, Anhui, 241001, People's Republic of China.
- 3Ambulatory Surgery Center, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China.
Abstract
Purpose
Dexamethasone is widely used as an adjuvant in multimodal analgesia after cesarean delivery; however, the optimal intravenous dose when combined with transversus abdominis plane block (TAPB) remains unclear. This study evaluated the efficacy and safety of three intravenous dexamethasone doses (5, 10, and 15 mg) as adjuncts to TAPB and explored the dose-response relationship between analgesic efficacy and safety.Patients and methods
This randomized, double-blind, placebo-controlled trial included 121 women undergoing cesarean delivery who comprised the per-protocol population. Intention-to-treat sensitivity analyses were also performed. Participants were assigned to control (C), dexamethasone 5 mg (D5), dexamethasone 10 mg (D10), and dexamethasone 15 mg (D15) groups. Study medication was administered intravenously after fetal delivery and umbilical cord clamping. All participants received bilateral TAPB with 20 mL of 0.25% ropivacaine per side, followed by patient-controlled intravenous analgesia (PCIA). The primary outcome was the duration of initial analgesia, defined as the time from TAPB completion to the first administration of rescue analgesia. Rescue analgesia was defined as an NRS pain score ≥4 or a patient request for additional analgesic medication. Secondary outcomes included PCIA consumption, NRS pain scores, postoperative blood glucose levels, and adverse events.Results
The Kaplan-Meier median duration of initial analgesia was 26 h in the control group and 29 h in the D5 group, and was not reached in the D10 and D15 groups. Compared with control, the risk of rescue analgesia was significantly reduced in D5 (HR 0.412, 95% CI 0.183-0.925, P=0.035), D10 (HR 0.229, 95% CI 0.090-0.582, P=0.002), and D15 (HR 0.162, 95% CI 0.055-0.484, P=0.001). No significant difference was observed between D10 and D15 (HR 1.411, 95% CI 0.398-4.998, P=0.594). Effective PCIA bolus demands were lower in D10 and D15 than in control. Postoperative blood glucose elevation was dose-dependent, with a smaller increase in D10 than in D15. Adverse events were comparable among groups.Conclusion
In this specific TAP block-based regimen without intrathecal morphine, 10 mg and 15 mg dexamethasone provided greater analgesic benefit than the control group or 5 mg dexamethasone, with no statistically significant difference between 10 mg and 15 mg. However, 15 mg was associated with a greater glycemic response. These findings suggest that 10 mg may be a reasonable clinical choice in this specific regimen and population, although the study was not designed or powered to establish equivalence or an optimal dose.
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BibTeX
@article{zhang2026doseresponse,
title = {{Dose-Response Effects of Intravenous Dexamethasone as an Adjunct to Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial.}},
author = {Jingjing Zhang and Lei He and Ting Liu and Ying Zhao and Jin Zhang and Peng Zhang and Dingdong Yang and Yao Lu},
journal = {Journal of pain research},
year = {2026},
month = oct,
doi = {10.2147/jpr.s641005},
url = {https://europepmc.org/article/MED/42960274},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Dose-Response Effects of Intravenous Dexamethasone as an Adjunct to Transversus Abdominis Plane Block for Postoperative Analgesia After Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Trial.
AU - Jingjing Zhang
AU - Lei He
AU - Ting Liu
AU - Ying Zhao
AU - Jin Zhang
AU - Peng Zhang
AU - Dingdong Yang
AU - Yao Lu
PY - 2026
DA - 2026/10/25
JO - Journal of pain research
DO - 10.2147/jpr.s641005
UR - https://europepmc.org/article/MED/42960274
AB - Purpose Dexamethasone is widely used as an adjuvant in multimodal analgesia after cesarean delivery; however, the optimal intravenous dose when combined with transversus abdominis plane block (TAPB) remains unclear. This study evaluated the efficacy and safety of three intravenous dexamethasone doses (5, 10, and 15 mg) as adjuncts to TAPB and explored the dose-response relationship between analgesic efficacy and safety.Patients and methods This randomized, double-blind, placebo-controlled trial included 121 women undergoing cesarean delivery who comprised the per-protocol population. Intention-to-treat sensitivity analyses were also performed. Participants were assigned to control (C), dexamethasone 5 mg (D5), dexamethasone 10 mg (D10), and dexamethasone 15 mg (D15) groups. Study medication was administered intravenously after fetal delivery and umbilical cord clamping. All participants received bilateral TAPB with 20 mL of 0.25% ropivacaine per side, followed by patient-controlled intravenous analgesia (PCIA). The primary outcome was the duration of initial analgesia, defined as the time from TAPB completion to the first administration of rescue analgesia. Rescue analgesia was defined as an NRS pain score ≥4 or a patient request for additional analgesic medication. Secondary outcomes included PCIA consumption, NRS pain scores, postoperative blood glucose levels, and adverse events.Results The Kaplan-Meier median duration of initial analgesia was 26 h in the control group and 29 h in the D5 group, and was not reached in the D10 and D15 groups. Compared with control, the risk of rescue analgesia was significantly reduced in D5 (HR 0.412, 95% CI 0.183-0.925, P=0.035), D10 (HR 0.229, 95% CI 0.090-0.582, P=0.002), and D15 (HR 0.162, 95% CI 0.055-0.484, P=0.001). No significant difference was observed between D10 and D15 (HR 1.411, 95% CI 0.398-4.998, P=0.594). Effective PCIA bolus demands were lower in D10 and D15 than in control. Postoperative blood glucose elevation was dose-dependent, with a smaller increase in D10 than in D15. Adverse events were comparable among groups.Conclusion In this specific TAP block-based regimen without intrathecal morphine, 10 mg and 15 mg dexamethasone provided greater analgesic benefit than the control group or 5 mg dexamethasone, with no statistically significant difference between 10 mg and 15 mg. However, 15 mg was associated with a greater glycemic response. These findings suggest that 10 mg may be a reasonable clinical choice in this specific regimen and population, although the study was not designed or powered to establish equivalence or an optimal dose.
SN - 1178-7090
ER -