Impact of Perioperative Dexamethasone on Postoperative Analgesia and Side-effects

Systematic Review and Meta-analysis

N. H. Waldron, C. A. Jones, T. J. Gan, T. K. Allen, A. S. Habib

Disclosures

Br J Anaesth. 2013;1(2):191-200. 

 

Abstract and Introduction

Abstract

The analgesic efficacy and adverse effects of a single perioperative dose of dexamethasone are unclear. We performed a systematic review to evaluate the impact of a single i.v. dose of dexamethasone on postoperative pain and explore adverse events associated with this treatment.

Methods MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for randomized, controlled studies that compared dexamethasone vs placebo or an antiemetic in adult patients undergoing general anaesthesia and reported pain outcomes.

Results Forty-five studies involving 5796 patients receiving dexamethasone 1.25–20 mg were included. Patients receiving dexamethasone had lower pain scores at 2 h {mean difference (MD) ™0.49 [95% confidence interval (CI): ™0.83, ™0.15]} and 24 h [MD ™0.48 (95% CI: ™0.62, ™0.35)] after surgery. Dexamethasone-treated patients used less opioids at 2 h [MD ™0.87 mg morphine equivalents (95% CI: ™1.40 to ™0.33)] and 24 h [MD ™2.33 mg morphine equivalents (95% CI: ™4.39, ™0.26)], required less rescue analgesia for intolerable pain [relative risk 0.80 (95% CI: 0.69, 0.93)], had longer time to first dose of analgesic [MD 12.06 min (95% CI: 0.80, 23.32)], and shorter stays in the post-anaesthesia care unit [MD ™5.32 min (95% CI: ™10.49 to ™0.15)]. There was no dose–response with regard to the opioid-sparing effect. There was no increase in infection or delayed wound healing with dexamethasone, but blood glucose levels were higher at 24 h [MD 0.39 mmol litre^™1 (95% CI: 0.04, 0.74)].

Conclusions A single i.v. perioperative dose of dexamethasone had small but statistically significant analgesic benefits.

Introduction

Glucocorticoids have been used to reduce inflammation and tissue damage in a variety of conditions, including inflammatory bowel disease, rheumatoid arthritis, and some malignancies. Glucocorticoids have potent immunomodulatory effects, and are used in the treatment of acute allograft rejection. They also have antiemetic properties and dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV).^[1–3]

Long-term treatment with glucocorticoids is associated with many side-effects.^[13] However, it is unclear if a single perioperative dose of dexamethasone increases the risk of these adverse effects. This is due to many of the published studies being underpowered to detect clinically relevant side-effects,^[2] and many studies also excluded patients at the highest risk of glucocorticoid-related adverse effects.^[1]The efficacy of glucocorticoids for reducing pain and inflammation after surgery has recently been explored. Early studies in patients undergoing dental procedures showed that glucocorticoids were effective in reducing postoperative pain and oedema.^[4–6] A number of recent studies have investigated the potential analgesic benefit of a single perioperative dose of dexamethasone but have inconsistent findings.^[7–12]

We therefore performed this systematic review to determine if a single perioperative dose of dexamethasone in adult surgical patients undergoing surgery under general anaesthesia has a useful analgesic effect in the postoperative period. We also investigated whether the use of dexamethasone increases the risk of postoperative adverse effects
.