This article reviews major trials and other studies of perioperative dexamethasone in adult noncardiac surgery, focusing on patient selection, optimal dose, and safety. Practice guidelines for postanesthetic care: An updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Dexamethasone is commonly used in anaesthesia to prevent postoperative nausea and vomiting (PONV). There were only four studies in the low-dose group and there were no head-to-head comparisons between low dose and higher doses, only comparisons with placebo. They found that intermediate and high dose but not low-dose dexamethasone reduced 24 h opioid consumption compared with placebo, and the reduction with intermediate and high doses was statistically higher than low dose. For continuous data, mean differences (MD) with 95% confidence interval (CI) were calculated. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery. Dr. Myles is supported by an Australian National Health and Medical Research Council (Canberra, Australia) Practitioner Fellowship. Most research into the analgesic benefits of corticosteroids has occurred in dental and maxillofacial surgery. Glucocorticosteroid therapy: Mechanisms of action and clinical considerations. The safety of the administration of this immunosuppressive agent at a time of significant immunological disruption has not been rigorously evaluated in terms of infective complications. Group B: employing the above two techniques. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. 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. Role of Dexamethasone on Oxygen Requirement, Mortality, and Survival Incidence among COVID-19 Patients: Quasi-Experimental Study . Corticosteroid administration in oral and orthognathic surgery: A systematic review of the literature and meta-analysis. Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia. Inflammatory markers in postoperative delirium (POD) and cognitive dysfunction (POCD): A meta-analysis of observational studies. Erectile dysfunction (ED) is often a symptom . had a special emphasis on the safety of antiemetic drugs.1 Adverse effects of interest included wound infection, extrapyramidal symptoms, sedation, constipation, headache, QT interval prolongation, and arrhythmias. Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reactions in injured teeth. Participants were randomly assigned to a single dose of 8 mg IV dexamethasone at induction of anesthesia compared with standard care. Results Twenty-four randomized clinical trials with 2,751 subjects were included. We recommend dexamethasone (4 to 8 mg) for the prophylaxis and treatment of postoperative nausea and vomiting; the higher dose provides an antiemetic benefit for up to 72 h.22 A dose of 8 mg IV dexamethasone provides some analgesic benefit, particularly in orthopedic, oral, and ear, nose, and throat surgeries, and otherwise improves patient QoR after surgery. A double-blind, randomized trial enrolling 106 female patients undergoing outpatient gynecological laparoscopy compared IV saline (control group), 0.05 mg/kg dexamethasone, or 0.1 mg/kg dexamethasone administered immediately before induction of anesthesia.38 The primary outcome was the global QoR-40 score at 24 h after surgery. Hospital discharge time was 30 min shorter after 0.1 mg/kg dexamethasone compared with saline (P = 0.005). Group D: Dexamethasone 0.15 mg/kg diluted in 5 ml saline (maximum dose 8 mg) was administered IV 15 min before induction of anesthesia. We followed the recommendations of the PRISMA statement in creating this review.14 The databases of MEDLINE (19662011), EMBASE, CINAHL, and the Cochrane Register of Controlled Trials were searched without language restrictions to identify full reports of randomized, controlled trials in which a single i.v. We also performed subgroup analysis using commonly used antiemetic doses (45 vs 810 mg). Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018. Perioperative use of gabapentinoids for the management of postoperative acute pain: A systematic review and meta-analysis. Trials were required to report pain outcomes such as pain scores, analgesic consumption, administration of rescue analgesics, or time to first dose of analgesic. There was evidence of dose responsiveness with respect to the 24 h pain scores [slope (95% CI)=0.041 (0.078, 0.005), P=0.026]. Blood glucose concentration profile after 10 mg dexamethasone in non-diabetic and type 2 diabetic patients undergoing abdominal surgery. Analyses were performed using the Review Manager (RevMan) Software Version 5.1 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark, 2008) and Comprehensive Meta Analysis software (Version 2.2.050). 1 Two recent meta-analyses have documented that dexamethasone also reduced postoperative pain and opioid requirement. Four studies11,24,39,49 (465 patients) recorded VAS with movement at 24 h after surgery. All postoperative opioid consumption was converted to morphine equivalents using the tableincluded in Supplementary Appendix S1. Results were consistent across prespecified subgroups, including in patients with diabetes (fig. Methods: A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. However, outcomes in terms of improvement and prolongation of analgesia, as well as the methods of administration and potential adverse effects, have yet to be clarified. In addition, the duration of most studies was limited to 24 h with very few reporting beyond 24 h after operation or the occurrence of chronic pain. dose of dexamethasone on postoperative pain and explore adverse events associated with this treatment. The PACMAN (Perioperative Administration of Corticotherapy on Morbidity and Mortality after Non-cardiac Surgery) trial was a pragmatic, double-blind, randomized trial that enrolled 1,222 patients undergoing major noncardiac surgery and compared IV saline (control group) with 0.2 mg/kg IV dexamethasone administered immediately after surgery, with a second 0.2 mg/kg dose administered on the day after surgery.44 The primary outcome was a composite of postoperative complications or all-cause mortality up to 14 days after surgery. The most compelling data, however, come from the recently published PADDI trial.43 Because of the ongoing concern that dexamethasone may increase the risk of surgical site infection, Corcoran et al. Effects of dexamethasone on post-operative cognitive dysfunction and delirium in adults following general anaesthesia: A meta-analysis of randomised controlled trials. There was no evidence of dose responsiveness with respect to this outcome [slope (95% CI)=0.169 (0.693, 0.355), P=0.526]. Early studies in patients undergoing dental procedures showed that glucocorticoids were effective in reducing postoperative pain and oedema.46 A number of recent studies have investigated the potential analgesic benefit of a single perioperative dose of dexamethasone but have inconsistent findings.712, Long-term treatment with glucocorticoids is associated with many side-effects.13 However, it is unclear if a single perioperative dose of dexamethasone increases the risk of these adverse effects. . Perspectives on preoperative exercise testing and training, The evolution of airway management new concepts and conflicts with traditional practice, The evolution of robotic surgery: surgical and anaesthetic aspects, Global lessons: developing military trauma care and lessons for civilian practice, Supplementary material is available at British Journal of Anaesthesia online, Copyright 2023 The British Journal of Anaesthesia Ltd. Pain intensity scores were assumed to be at rest unless otherwise noted. 1). Unfortunately, there are very few head-to-head dose comparisons. ASA, American Society of Anesthesiologists; BMI, body mass index. Introduction The intraoperative administration of dexamethasone for prophylaxis against postoperative nausea and vomiting is a common and recommended practice. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. One study reported mean opioid consumption in milligrams per kilogram.20 This was converted to total milligrams using 70 kg as the patients' average weight based upon data from the National Public Health Institute of Finland, where this study was performed.21 In papers using the median, range, or both as a measure of central tendency, an attempt was made to contact the author and secure group data as mean and standard deviation. dexamethasone on postoperative dizziness, nausea and pain during canal wall-up mastoidectomy, Role of dexamethasone in reducing pain after endoscopic sinus surgery in adults: a double-blind prospective randomized trial, Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial, Effect of steroids on posttonsillectomy pain in adults, Dexamethasone effectively reduces postoperative nausea and vomiting in a general surgical adult patient population, Randomized clinical trial of the effect of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy, Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy, The effect of dexamethasone upon patient-controlled analgesia-related nausea and vomiting, Effect of dexamethasone on postoperative emesis and pain, Use of dexamethasone on the prophylaxis of nausea and vomiting after tympanomastoid surgery, Effects of dexamethasone on early postoperative pain, nausea and vomiting and recovery time after ambulatory laparoscopic surgery, Effect of ondansetron combined with dexamethasone on postoperative nausea & vomiting and pain of patients with laparoscopic hysterectomy, Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial. This represents a 13.0% decrease in pooled opioid consumption compared with control. Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV), and recent reviews suggest a role for dexamethasone in postoperative analgesia. Five studies included multiple doses of dexamethasone,11,12,20,24,25 and 38 studies had at least one group that received only dexamethasone.712,20,2555 Nine studies had at least one group that received dexamethasone in combination with a serotonin (5-HT3) receptor antagonist.24,47,50,5661 Two studies included a group that received dexamethasone and midazolam,48,55 one study included a group that received both metoclopramide and dexamethasone,49 and another included a group that received both haloperidol and dexamethasone.46 Dexamethasone was given before operation in 28 studies712,20,24,25,27,28,3034,36,38,39,4144,47,48,51,56,59 and intraoperatively in 18.26,29,35,37,40,42,45,46,49,50,5255,57,58,60,61 One study42 randomized patients to receive dexamethasone either before operation or intraoperatively. Head-To-Head dose comparisons Journal of anaesthesia role of dexamethasone in anaesthesia levitra soft, body mass index with and. 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