Effect of Preoperative Paracetamol and Intraoperative Dexamethasone on Postoperative Pain and Analgesic Requirement in Cesarean Section: A Randomized Controlled Trial
DOI:
https://doi.org/10.54112/bcsrj.v7i4.2265Keywords:
Acetaminophen; Anesthesia, Spinal; Cesarean Section; Dexamethasone; PainAbstract
Postoperative pain after cesarean section remains a major clinical concern and may increase analgesic requirement, delay mobilization, and affect maternal recovery. Preemptive and multimodal analgesic strategies may improve postoperative pain control after spinal anesthesia. Objective: To evaluate the effect of preoperative intravenous paracetamol, intraoperative intravenous dexamethasone, and their combination on postoperative pain intensity and analgesic requirement in patients undergoing elective cesarean section under spinal anesthesia. Methods: This prospective randomized controlled trial was conducted in the Department of Anesthesia, Noor Hospital, Lahore, among 150 patients undergoing elective cesarean section under spinal anesthesia from August 2025 to January 2026. Patients were randomly allocated into three equal groups of 50 patients each. Group A received intravenous paracetamol 1 g preoperatively, Group B received intravenous dexamethasone 8 mg intraoperatively after cord clamping, and Group C received both intravenous paracetamol and dexamethasone using the same protocol. Postoperative pain was assessed using the Visual Analogue Scale at predefined postoperative intervals. Time to first analgesic request and total analgesic consumption were recorded during the first 6 postoperative hours. Data were analyzed using appropriate descriptive and inferential statistics. Continuous variables were compared among groups using one-way analysis of variance or the Kruskal–Wallis test, as appropriate, while categorical variables were analyzed using the chi-square test. A p-value <0.05 was considered statistically significant. Results: The combination group demonstrated significantly better postoperative analgesic outcomes compared with either drug alone. Patients in Group C had a significantly prolonged time to first analgesic request and reduced total analgesic consumption compared with Groups A and B (p<0.001). Visual Analogue Scale scores were also significantly lower in Group C at all observed postoperative time intervals, indicating improved pain control with combined preoperative paracetamol and intraoperative dexamethasone. Conclusion: Combined preoperative intravenous paracetamol and intraoperative intravenous dexamethasone provided more effective postoperative analgesia than either intervention alone in patients undergoing cesarean section under spinal anesthesia. This multimodal approach may reduce early postoperative pain intensity and analgesic requirement.
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1. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. DOI: https://doi.org/10.1136/bmjgh-2021-005671
2. Amjad A, Imran A, Shahram N, Zakar R, Usman A, Zakar MZ, et al. Trends of caesarean section deliveries in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018. BMC Pregnancy Childbirth. 2020;20(1):753. DOI: https://doi.org/10.1186/s12884-020-03457-y
3. Rana MS, Mazumder S, Khan MTF, Khan MMH, Rahman MM. Trends and determinants of caesarean section in South Asian countries: Bangladesh, Nepal, and Pakistan. PLoS One. 2024;19(12):e0311082. DOI: https://doi.org/10.1371/journal.pone.0311082
4. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. DOI: https://doi.org/10.1097/j.pain.0000000000001939
5. American College of Obstetricians and Gynecologists’ Committee on Clinical Consensus-Obstetrics. Pharmacologic stepwise multimodal approach for postpartum pain management: ACOG Clinical Consensus No. 1. Obstet Gynecol. 2021;138(3):507-517. DOI: https://doi.org/10.1097/AOG.0000000000004517
6. Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M, et al. Society for Obstetric Anesthesia and Perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132(5):1362-1377. DOI: https://doi.org/10.1213/ANE.0000000000005257
7. Sultan P, Monks DT, Sharawi N, Bamber J, Panelli DM, Sauro KM, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 3)-2025 update. Am J Obstet Gynecol. 2026;233(6S):S184-S198. DOI: https://doi.org/10.1016/j.ajog.2025.01.038
8. Roofthooft E, Joshi GP, Rawal N, Van de Velde M; PROSPECT Working Group. PROSPECT guideline for elective caesarean section: an update. Anaesthesia. 2023;78(9):1170-1171. DOI: https://doi.org/10.1111/anae.16034
9. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-448. DOI: https://doi.org/10.1213/ANE.0000000000004833
10. Myles PS, Corcoran T. Benefits and risks of dexamethasone in noncardiac surgery. Anesthesiology. 2021;135(5):895-903. DOI: https://doi.org/10.1097/ALN.0000000000003898
11. Pakzad Moghadam SH, Pourparizi M, Mirzaei T, Ravari A, Mirzaeikhalilabadi S. Analgesic effect of preoperative intravenous administration of paracetamol on post-cesarean pain: a randomized clinical trial. Anesth Pain Med. 2023;13(1):e134316. DOI: https://doi.org/10.5812/aapm-134316
12. Aksoy H, Ak M, Gokahmetoglu G, Aksoy U. The comparison of intraincisional bupivacaine infiltration and intravenous paracetamol administration for pain alleviation after cesarean section: a double-blinded randomized placebo-controlled clinical trial. Eur Rev Med Pharmacol Sci. 2023;27(8):3467-3474.
13. Shakeel A, Aziz S, Shakeel B, Naeem M, Irfan W, Ali RN. Comparison of outcome in patients undergoing elective cesarean delivery with intravenous acetaminophen versus placebo. Professional Med J. 2025;32(6):714-719. DOI: https://doi.org/10.29309/TPMJ/2025.32.06.8808
14. Mehdiratta JE, Dominguez JE, Li YJ, Saab R, Habib AS, Allen TK, et al. Dexamethasone as an analgesic adjunct for postcesarean delivery pain: a randomized controlled trial. Anesthesiol Res Pract. 2021;2021:4750149. DOI: https://doi.org/10.1155/2021/4750149
15. Ioannopoulos D, Tsani Z, Chatsiou E, Arnaoutoglou E, Tsaousi G. Efficacy and safety of intravenous administration of dexamethasone on post-cesarean delivery pain: a systematic review and meta-analysis of current literature. Int J Obstet Anesth. 2025;63:104682. DOI: https://doi.org/10.1016/j.ijoa.2025.104682
16. Abebe M, Alemu B, Teku G, Eshetu O, Wale E, Besha A, et al. Effectiveness of single intravenous dexamethasone in prolongation of spinal anesthesia for postoperative analgesia in elective cesarean section: a systematic review of randomized controlled trials. J Pain Res. 2024;17:1361-1368. DOI: https://doi.org/10.2147/JPR.S451595
17. Ravishankar N, Kalingarayar S, Govarthanan S. Comparison of perioperative single-dose systemic dexamethasone versus placebo for prolongation of postoperative analgesia in term parturients undergoing cesarean section under spinal anesthesia. Cureus. 2025;17(8):e90011. DOI: https://doi.org/10.7759/cureus.90011
18. Grasch JL, Rojas JC, Sharifi M, McLaughlin MM, Bhamidipalli SS, Haas DM. Impact of Enhanced Recovery After Surgery pathway for cesarean delivery on postoperative pain. Am J Obstet Gynecol Glob Rep. 2023;3(1):100169. DOI: https://doi.org/10.1016/j.xagr.2023.100169
19. Siwicki A, Adams RM, Cabasa K, Madan S, Ouillette H. Postpartum pain management for women undergoing cesarean sections using a multimodal pain control protocol: a retrospective study. BMC Pregnancy Childbirth. 2025;25(1):1318. DOI: https://doi.org/10.1186/s12884-025-07607-y
20. Zhao ZM, Yang JQ, Wang GX, Yu XJ, Feng Y. A meta-analysis of the effects of multimodal intervention measures on the recovery of postpartum women after cesarean section. Front Med (Lausanne). 2025;12:1690139. DOI: https://doi.org/10.3389/fmed.2025.1690139
21. Li L, Wan W, Zhu C. Breastfeeding after a cesarean section: a literature review. Midwifery. 2021;103:103117. DOI: https://doi.org/10.1016/j.midw.2021.103117
22. Singh NP, Makkar JK, Yadav N, Goudra BG, Singh PM. The analgesic efficacy of intravenous dexamethasone for postcaesarean pain: a systematic review with meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2022;39(6):498-510. DOI: https://doi.org/10.1097/EJA.0000000000001626
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Copyright (c) 2026 Muhammad Bilal, Haseeb Ur Rehman, Hafiz Wajih Ul Hassan, Muhammad Junaid Baghdadi, Ali Athar, Tariq Abbasi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
