Effect of Intravenous Dexamethasone on Hemodynamic Stability and Perioperative Nausea and Vomiting During Spinal Anesthesia for Cesarean Delivery: A Prospective Observational Study from Palestine

Background Spinal anesthesia is the preferred technique for cesarean delivery due to its rapid onset and minimal fetal drug exposure. However, hypotension and perioperative nausea and vomiting (PONV) remain frequent and distressing complications. Dexamethasone has been suggested to attenuate these adverse effects through its anti-inflammatory and antiemetic properties, yet evidence from low-resource settings remains limited. This study aimed to evaluate the association between intravenous dexamethasone and perioperative outcomes, recognizing that causal relationships cannot be inferred from observational data. Methods This prospective observational cohort study was conducted at Rafidia Governmental Hospital, Palestine. One hundred women undergoing elective cesarean delivery under spinal anesthesia were included and grouped according to routine clinical administration of intravenous dexamethasone (8 mg) or no dexamethasone. The primary outcome was the incidence of spinal anesthesia–associated hypotension. Secondary outcomes included serial hemodynamic parameters, nausea, vomiting, patient satisfaction, and minor adverse events. Fluid administration, vasopressor use, and other adjunct medications were not standardized, and residual confounding may exist. Data were analyzed using repeated-measures analysis of variance and chi-square tests. No formal power calculation was performed due to the observational nature of the study. Results Baseline demographic and clinical characteristics were comparable between groups. Women who received dexamethasone demonstrated more stable perioperative blood pressure profiles and a significantly lower incidence of postoperative nausea (12% vs. 36%, p = 0.003) and vomiting (4% vs. 20%, p = 0.02). Patient satisfaction scores were higher in the dexamethasone group (8.5 ± 1.0 vs. 6.9 ± 1.2, p < 0.001). No serious adverse events were observed. Residual confounding and the observational design limit causal inference. Conclusions Intravenous dexamethasone was associated with improved hemodynamic stability, reduced PONV, and higher patient satisfaction in women undergoing cesarean delivery under spinal anesthesia. While causality cannot be confirmed, these findings support its practical use as a simple, accessible, and low-cost adjunct, highlighting the need for randomized controlled trials to confirm causal effects.