More consistent analgesic effects seen with preoperative administration of dexamethasone
THURSDAY, Sept. 1 (HealthDay News) -- Dexamethasone at doses of greater than 0.1 mg/kg decreases postoperative pain and reduces opioid consumption, according to a meta-analysis published in the September issue of Anesthesiology.
Gildasio S. De Oliveira, Jr., M.D., from Northwestern University in Chicago, and colleagues investigated the dose-dependent analgesic effects of perioperative dexamethasone using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses statement guidelines. Controlled trials that evaluated the effects of a single dose of systemic dexamethasone on postoperative pain and opioid consumption were identified and the meta-analysis was performed using a random-effect model. The studies included in the analysis were grouped into three dosage-groups: low (<0.1 mg/kg), intermediate (0.11 to 0.2 mg/kg) and high (≥0.21 mg/kg).
The investigators found that 24 trials, including 2,751 subjects, fit the criteria. The mean combined effects showed dexamethasone as superior to the placebo for pain at rest (≤4 hours, −0.32; 24 hours, −0.49) and with movement (≤4 hours, −0.64; 24 hours, −0.47). Opioid consumption was reduced with both intermediate and high dose dexamethasone (−0.82 and −0.85, respectively), but not with low dose dexamethasone (−0.18). There was no increase in analgesic effectiveness or decrease in opioid use between high and intermediate doses of dexamethasone. Compared to intraoperative administration, the preoperative administration of dexamethasone produced more consistent analgesic effects.
"Dexamethasone at doses >0.1 mg/kg is an effective adjunct in multimodal strategies to reduce postoperative pain and opioid consumption after surgery," the authors write.