TY - THES ID - 137471093 TI - Hoge versus lage dosis dexamethason voor postoperatieve pijnbestrijding na keizersnede: een gerandomiseerde, dubbel-blinde, twee-center studie AU - Evers, Claire AU - Van De Velde, Marc AU - Roofthooft, Eva Dirk Rita AU - Huygens, Christel AU - KU Leuven. Faculteit Geneeskunde. Opleiding Master in de biomedische wetenschappen (Leuven) PY - 2022 PB - Leuven KU Leuven. Faculteit Geneeskunde DB - UniCat UR - https://www.unicat.be/uniCat?func=search&query=sysid:137471093 AB - Background: Moderate to severe postoperative pain remains a problem for patients undergoing caesarean sections. A multimodal analgesia regimen, as recommended by the PROSPECT guidelines, includes the administration of dexamethasone. Previous studies have shown correlations between high-dose dexamethasone administration and improved postsurgical analgesia in addition to the antiemetic effects of the drug. Objectives: The intention of this double-blind randomized controlled trial is to compare a high- and a low-dose of dexamethasone when added to a multimodal analgesia regimen in the postoperative setting after a caesarean section. This thesis focusses on the association between predisposing factors for and effects on the need for rescue medication for pain. Methods: The study protocol was approved by both the Central Ethics Committee and the national regulatory authorities (EudraCT 2020-005681-33). Seventy-five patients were included before January 31, 2022, and randomly allocated in the high-dose (two doses of 25 mg dexamethasone) or the low-dose group (one dose of 5 mg dexamethasone and one dose of placebo). We performed a blinded interim analysis of this randomized controlled trial. All patients, independent of their assigned groups, were divided in two groups based on their use of rescue analgesics. Possible predictive factors for the use of rescue analgesics were investigated, in addition to possible implications of this drug use. Results: A total of 43 patients (57%) had a need for rescue analgesics. No predictive factors for rescue analgesic use could be determined from collected pre- and intraoperative data. Patients who required rescue analgesia during this trial experienced more postoperative pain on multiple timepoints in the postpartum period. Breastfeeding was not influenced by the experience of post caesarean pain but a negative association between postoperative pain and patient recovery was found. Patients in need of additional rescue analgesia also scored lower on a patient satisfactory numerical rating scale. No patients were diagnosed with delirium during the follow up period. Conclusion: Postoperative pain is a clear precipitating factor for rescue analgesia use and post caesarean pain has a clear negative effect on the patient recovery and analgesia satisfaction. Strong indications were found that a dose of 25 mg dexamethasone does not cause delirium in our patient population. ER -