RESUMEN
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
RESUMEN
The purpose of the study was to determine whether maternal serum levels of androgen and progesterone, are higher in patient with preeclampsia than in matched control subjects. Serum progesterone, total testosterone, free testosterone and dehydroepiandrosterone levels were measured in 19 subjects in third trimester of pregnancy with documented preeclampsia and 17 healthy normotensive women with similar maternal and gestational ages. All subjects were primigravida women with singleton pregnancy who were visited in Kosar Medical center in Uromiyeh. There were no significant differences between two groups in maternal age, gestational age and body mass index. Progesterone and free testosterone levels were significantly lower [p=0.01] in patients with preeclampsia [75.1 +/- 8.6 ng/dL and 2.27 +/- 1.71 pg/dL, respectively] than in control group [111.6 +/- 9.71 ng/dL and 3.73 +/- 1.31 pg/dL, respectively]. There were no significant differences in total testosterone and dehydroepiandrosterone levels between cases [1.02 +/- 0.10 ng/dL and 0.99 +/- 0.13 micro g/dL, respectively] and controls [1.37 +/- .019 ng/dL and 0.98 micro 5.15 micro g/dL, respectively]. Accentuated sex hormone binding globulin increase in preeclampsia is the cause of significant decreased free testosterone of preeclamptic cases. Levels of progesterone were pathologically and significantly lower in preeclamptic cases than control women with similar age, gestational age and body mass index. This difference raises the possibility for a role of progesterone in the pathogenesis of preeclampsia