Intravenous dexamethasone may represent an effective analgesic strategy during labor and result in drug dose sparing of both levobupivacaine and fentanyl, according to results of a randomized double-blind placebo-controlled trial published in the Journal of Clinical Anesthesia.

Researchers investigated the effect of intravenously administered dexamethasone as a pain-relieving adjunct in 80 patients who requested an epidural during early spontaneous labor. Patients were randomly assigned to receive intravenous dexamethasone (8 mg in 50 mL normal saline) 45 minutes prior to the procedure, or 50 mL normal saline only.

All study participants underwent epidural analgesia, receiving a continuous infusion of 0.1% levobupivacaine at a rate of 5 mL/hour in addition to 2 μg/mL of fentanyl. The average hourly consumption of the levobupivacaine-fentanyl combination was the study’s primary outcome.

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Patients who received dexamethasone demonstrated significantly lower average hourly consumption of the levobupivacaine-fentanyl combination compared with those receiving placebo only (10.34±1.79 mL/h vs 11.34±1.83 mL/h; mean difference, 1.007; 95% CI, 0.199-1.815; P =.015). No significant differences were observed between treatment and placebo groups for maternal satisfaction, hemodynamics, adverse effects, or pain scores.

The investigators believe that the lack of estimation of dexamethasone blood levels represents a potential limitation to this study.

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Although the mechanism underlying the analgesic effect of dexamethasone during labor has yet to be established, the investigators believe it may “involve activation and transcription of genes relevant to inflammation and pain modulation.”

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Dube P, Mitra S, Singh J, Saroa R, Mehra R. Intravenous dexamethasone as an adjunct to improve labor analgesia: a randomized, double-blinded, placebo controlled clinical trial. J Clin Anesth. 2017;43:6-10.