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

• Published in: British journal of anaesthesia : BJA Vol. 110; no. 2; pp. 191 - 200
• Main Authors: Waldron, N.H., Jones, C.A., Gan, T.J., Allen, T.K., Habib, A.S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2013; Oxford University Press
• Series: Editor's choice
• Subjects: analgesics, opioid; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia Recovery Period; Anesthesia, General; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Confidence Intervals; dexamethasone; Dexamethasone - adverse effects; Dexamethasone - therapeutic use; Endpoint Determination; Female; glucocorticoids; Humans; hyperglycaemia; Male; Pain Measurement; pain, postoperative; Pain, Postoperative - epidemiology; Pain, Postoperative - prevention & control; Review; Risk; surgical wound infection; Treatment Outcome; dexamethasone; hyperglycaemia; glucocorticoids; analgesics, opioid; surgical wound infection; pain, postoperative
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aes431

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.