Comparative effectiveness of dexamethasone versus methylprednisolone for neuropathic outcomes after combined spinal-epidural labor analgesia: a prospective, randomized, double-blind trial

Background Paresthesias occurring during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement may lead to nerve injury. We compared the effects of epidural dexamethasone versus methylprednisolone on neurological outcomes. Methods In this prospective, randomized, double-blind clinical trial conducted at a Chinese obstetrics hospital, parturients who developed paresthesias during combined spinal-epidural labor analgesia due to needle puncture or epidural catheter placement were randomized to receive an epidural injection of dexamethasone (5 mg) or methylprednisolone (40 mg). The primary outcome was neurological function at 14 days postpartum, including impaired skin sensation, decreased muscle strength, or other neurological symptoms. Secondary outcomes included adverse events and changes in inflammatory biomarkers. Results A total of 315 parturients were randomized and completed the study. At 14 days postpartum, the neurological function outcomes did not differ significantly between the two groups ( p > 0.05). Among the secondary outcomes, the dexamethasone group had a higher incidence of epidural-related maternal fever (ERMF) (7.6% vs. 2.5%, p < 0.05), and the 24-h postpartum serum Interleukin-6 (IL-6) level was significantly higher than that in the methylprednisolone group [26.1 (18.2–38.9) pg./mL vs. 15.4 (13.2–17.6) pg./mL, p < 0.05]. There were no significant differences between the two groups in postpartum hemorrhage, nausea and vomiting, instrumental delivery rate, Neonatal Intensive Care Unit (NICU) admission rate, or 24-h postpartum serum C-reactive protein (CRP) level ( p > 0.05). Conclusion In parturients who developed paresthesia during combined spinal-epidural labor analgesia, epidural administration of dexamethasone or methylprednisolone resulted in comparable neurological outcomes at 14 days postpartum. Clinical trial registration https://www.chictr.org.cn/ , identifier ChiCTR2300078866