Merits of widespread single-dose dexamethasone as part of a comprehensive perioperative pain management plan.
Hai Chuan Yu1, P. Timothy Pollak1,2, Geoffrey S Hawboldt1,3
1. University of Calgary Cumming School of Medicine; 2. Department of Medicine, University of Calgary Cumming School of Medicine ; 3. Department of Anesthesia, University of Calgary Cumming School of Medicine
Dexamethasone is used perioperatively for the prevention of postoperative nausea and vomiting (PONV). Systemic perioperativedexamethasone has been found to reduce postoperative pain and opioid consumption. Given the concerns surrounding the perioperative use of NSAIDs as analgesic agents, dexamethasone may be substituted as an adjunct analgesic to provide peri- and post-operative analgesia without the side effects associated with NSAIDs.
MEDLINE, PubMed, and EMBASE databases were searched for peer-reviewed journal articles discussing the use of perioperative, single-dose dexamethasone. Risks, benefits and potential as an adjunct to analgesia were reviewed. The bibliographies of the most comprehensive manuscripts were inspected to ensure that no major references were overlooked. All authors independently reviewed the search results and reached consensus for inclusion in this review’s bibliography.
Current literature suggests that dexamethasone at doses similar to those used for PONV prophylaxis (8-10mg) also provides an analgesic effect, reducing both early and late postoperative pain at rest and with movement, while decreasing opioid demand and delaying patients' demand for analgesics (Table 1). Perioperativedexamethasone administration also reduces both length of postoperative hospital stay and alleviates sore throat after endotracheal intubation. Currently, it is unclear whether dexamethasone at doses lower than 8-10mg can contribute to improved postoperative analgesia.
Overall, evidence in the current literature indicates a favorable safety profile of perioperativedexamethasone, with most of the potential adverse effects relating to chronic steroid use (Table 2). Some adverse effects such as perineal irritation and postoperative hyperglycemia are associated with single-dose dexamethasone in the perioperative period, and should be monitored and treated promptly.
In conclusion, the strong evidence demonstrating the efficacy of dexamethasone as an adjunctive agent in pain management combined with its overall safety as a single-dose perioperative medication suggests that its routine perioperative use be considered in most patients.