Hysterectomy, a common surgical procedure, is frequently associated with moderate-to-severe postoperative pain and a high incidence of postoperative nausea and vomiting (PONV). Dexamethasone, a corticosteroid, may help alleviate these symptoms; however, existing evidence is largely drawn from mixed surgical populations and does not specifically address its efficacy and safety in hysterectomy patients. This meta-analysis provides a focused and updated synthesis of randomised controlled trials (RCTs) in this population, incorporating time-stratified pain outcomes and subgroup analyses by dose, surgical approach, timing and route of administration to evaluate the role of dexamethasone in postoperative recovery.

Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

PubMed, Scopus, Google Scholar and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 1 November 2024.

We included RCTs comparing dexamethasone with placebo for postoperative outcomes in hysterectomy patients.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.

15 RCTs (1362 patients) were included. Dexamethasone significantly reduced PONV (risk ratio (RR): 0.53, 95% CI 0.47 to 0.61, p2: 0% high certainty) and pain scores at 24 hours (mean difference (MD): –0.20, 95% CI –0.35 to –0.05, p=0.009, I²=0%, moderate certainty), 8–12 hours (MD: –0.60, 95% CI –0.88 to –0.31, p2: 27%, moderate certainty and 4 hours (MD: –0.43, 95% CI –1.07 to 0.21, p=0.19, 93%, moderate certainty). It also decreased the use of rescue antiemetics (RR: 0.57, 95% CI 0.43 to 0.75, I²: 39%, high certainty) and postoperative opioid consumption (standardised MD: –0.48, 95% CI –0.90 to –0.05, p=0.03, I²: 74%, low certainty). The effects of rescue analgesics and hospital stay duration were nonsignificant. Subgroup analyses showed consistent antiemetic efficacy of dexamethasone across doses, timings, routes and procedures. For pain, greater analgesic effects were seen with higher doses and perineural administration, particularly at 8–12 hours. The risk of bias was low in most studies, but evidence of publication bias was observed for the pain score outcome.

Dexamethasone is an effective adjunct in hysterectomy, significantly reducing PONV and postoperative pain at 8–12 and 24 hours, particularly with 4–10 mg doses. Benefits are consistent across routes, timings and surgical approaches, with greater early analgesia after perineural use. It reduces opioid consumption but has a limited effect on rescue analgesia, supporting its role as a complementary analgesic. While generally considered safe, current safety data are limited, highlighting the need for further research. These results support its use in multimodal recovery protocols and identify priorities for future studies in high-risk and diverse surgical populations.

CRD42024608067.

The study aims to explore the experiences of adolescent girls with the onset of their first menstruation in the context of Pakistan and to highlight the sociocultural aspects that shape those experiences.

The study employs an exploratory phenomenological approach.

This study has been conducted at a public sector higher education institute, University of the Punjab, Pakistan. Female students enrolled in the first semester of the undergraduate degree programme were included in the study using a predefined inclusion and exclusion criteria.

Data was collected from six 18 years old girls who had their menarche in the last 6 years through face-to-face in-depth interviews using a semi-structured interview guide from June 2024 to August 2024. The interviews were audio-recorded given the written consent of the participants. Transcripts were analysed thematically following Braun and Clarke’s framework.

Thematic analysis of six interviews revealed three major themes: (1) Experience of first blood: emotional, social and practical difficulties; (2) The problem of mismanagement of first menstruation and the strategies used; and (3) Restrictions during menstruations. The study found that adolescent girls are provided with little to no prior knowledge regarding menarche and menstruation that causes various complexities and vulnerabilities. The social and cultural expectations and the gendered norms construct the experiences of the adolescent girls regarding their first menstruation, while the idea of womanhood is preserved in the society by restricting, isolating and alienating the adolescent girls and modifying their conduct and behaviour accordingly.

Menarche is often experienced as distressing, secretive and isolating for adolescent girls in Pakistan. Educational interventions in families and schools are needed to provide accurate, timely information and to support girls in navigating this transition with confidence and dignity.