Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis

Summary by Sanam Babbar MD, 4.4.23
https://pubmed.ncbi.nlm.nih.gov/23220857/


Take Home Points:

  • Single Dose IV Dexamethasone appears to have small but statistically significant analgesic effects in the postoperative period. 

  • Meta-analysis of 45 studies found lower pain scores and lower opioid requirement at 2h and 24 hour mark 

  • There was no increased risk of infection or delayed wound healing, although it was associated with slight hyperglycemia on postoperative day one. 

 

Summary:

 

Background: The efficacy of glucocorticoids for reducing pain and inflammation after surgery has recently been explored. Study performed this systematic review to determine if a single perioperative dose of dexamethasone in adult surgical patients undergoing surgery under general anesthesia has a useful analgesic effect in the postoperative period. They also investigated whether the use of dexamethasone increases the risk of postoperative adverse effects.

 

Study Design: Metanalysis 

 

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 anesthesia and reported pain outcomes.

 

Inclusion Criteria: Full reports of randomized, controlled trials in which a single IV dose of dexamethasone was given perioperatively to adult patients undergoing surgery under general anesthesia and was compared with either placebo or another antiemetic agent. Keywords used in the search included ‘dexamethasone’, ‘steroids’, ‘corticosteroids’, ‘glucocorticoids’, ‘pain’, ‘postoperative pain’, ‘nausea’, ‘vomiting’, ‘postoperative nausea and vomiting’, and ‘surgery’.rials were required to report pain outcomes such as pain scores, analgesic consumption, administration of rescue analgesics, or time to first dose of analgesic. Trials were included if they measured pain as either a primary or secondary outcome. 

 

Exclusion Criteria: intrathecal or epidural local anesthetics or opioids, studies using high doses of dexamethasone (>20 mg), studies involving dental/endodontic procedure, Data from abstracts, letters to the editor, retrospective trials, and case reports

 

Primary Outcome: Pain (Including 2h and 24h opioid/ morphine consumption and 2h and 24h pain scores; time until first analgesic dosed)

 

Secondary Outcome: Side effects of glucocorticoid administration including wound healing, wound Infection, blood glucose; Duration of stay in post anesthesia unit 

 

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-anesthesia 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. 

 

 

Discussion/ conclusion: In this meta-analysis, patients treated with dexamethasone experienced less postoperative pain, required less postoperative opioids, had longer time to first analgesic dose, needed less rescue analgesia, and had shorter PACU stays. Patients having laparoscopic surgery showed no difference in opioid consumption, but after open abdominal surgery, there was a 3 mg (16.8%) morphine reduction in the first 24 h. The study found no increase in infection associated with steroid administration. Patients receiving dexamethasone had small but statistically significant elevations in blood glucose at 24 h after operation. A single perioperative dose of dexamethasone has been shown to elevate intraoperative blood glucose for 4 h.