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

Published

Journal Article (Review)

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

Full Text

Duke Authors

Cited Authors

  • Waldron, NH; Jones, CA; Gan, TJ; Allen, TK; Habib, AS

Published Date

  • February 2013

Published In

Volume / Issue

  • 110 / 2

Start / End Page

  • 191 - 200

PubMed ID

  • 23220857

Pubmed Central ID

  • 23220857

Electronic International Standard Serial Number (EISSN)

  • 1471-6771

International Standard Serial Number (ISSN)

  • 0007-0912

Digital Object Identifier (DOI)

  • 10.1093/bja/aes431

Language

  • eng