Postoperative Dexamethasone on Post-Cesarean Pain
Postoperative Dexamethasone on Post-Cesarean Pain
Investigating if giving post-operative dexamethasone to patients with a history of opioid use
 disorder on medication assisted treatment during pregnancy improves their pain scores and
 decreases their opioid use after cesarean section.
For this study, the researchers are most interested in an option that would be able to be
 administered consistently (same time/same way): that labor nurses could give and without
 requiring the patient to have had an epidural placement. Further, Gabapentin, clonidine and
 ketamine are associated with CNS effects like sedation or confusion that could make health
 care providers less likely to be comfortable giving these women additional oxycodone due to
 possible worsened sedation or respiratory depression. Lastly, the researchers wanted to give
 a drug that both obstetricians and pediatricians were comfortable with from extensive use in
 our maternal population. Thus, a single administration IV dexamethasone was chosen for this
 study. Dexamethasone has been used as an adjunct for post-operative pain management in many
 types of surgeries. Although no large randomized trials exist, several small trials suggest
 an analgesic and opioid sparing effect of dexamethasone post-operatively for both pregnant
 and non-pregnanat patients; however these studies excluded patients on MAT
Inclusion Criteria:

 -  English-speaking,

 -  History of opioid use disorder with current use of MAT during pregnancy,

 -  Scheduled for cesarean delivery for their current pregnancy for any indication
 [examples of elective c-section (decision made for c-section to be performed prior to
 onset of labor): fetal malpresentation, suspected macrosomia, prior c-section,
 abnormal placentation, patient preference],

 -  Negative toxicology screen upon admission to the hospital for their cesarean section,
 no prior administration of betamethasone for fetal lung maturity within 24h of their
 scheduled cesarean delivery

 Exclusion Criteria:

 -  non-english speaking,

 -  screen positive for illicit substance(s) on their admission toxicology screen,

 -  require general anesthesia for their cesarean section due to maternal/fetal indication
 for non-anticipated urgency (thus no longer 'elective') or failure of adequate intra-
 operative pain control with spinal anesthesia,

 -  medical history including known cardiovascular disease, heart failure, uncontrolled
 hypertension, uncontrolled gestational diabetes or uncontrolled pregestational
 diabetes, active GI bleed or untreated peptic ulcer,

 -  untreated infectious diseases including tuberculosis, systemic candida