Effect of dexamethasone on postoperative morbidity after dental rehabilitation in children

Abstract

Purpose Dexamethasone reduces postoperative morbidity after adenotonsillectomy, strabismus surgery, and third molar extraction. Our hypothesis was that dexamethasone would reduce pain and other morbidity in children undergoing dental surgery for up to 24 hr postoperatively. Methods A triple-blinded, randomized, controlled trial was carried out on 200 children undergoing prolonged dental rehabilitation under general anesthesia. Subjects were randomized into two groups: group D, given dexamethasone 0.3 mgÁkg -1 ; group S, given normal saline. The primary outcome measure was pain over 24 hr as evaluated by a parental 0-10 numerical rating scale (NRS). Key secondary outcomes included oral intake on a four-point scale at 24 hr and the overall incidence of postoperative vomiting (POV). Analysis for the primary outcome consisted of comparison of means in the NRS with the Wilcoxon rank sum test and for occurrence of POV with Fisher's test. Results After eliminating 22 subjects for protocol violations and withdrawals, 178 subjects were analyzed. There was no significant difference in pain scores (NRS) at 24 hr or the worst NRS experienced over the preceding 24 hr. There was no difference in the quality of oral intake between the groups. There was a significant difference in the percentage of patients who vomited during the first 24 hr: eight of 91 in group S and one of 87 in group D. Therefore, 7.74% more vomited in group S (P = 0.045), with a 95% confidence interval of 0.32 to15.16 for the difference in percentages. Conclusions Dexamethasone, 0.3 mgÁkg -1 , did not reduce pain over 24 hr in healthy children undergoing dental rehabilitation under general anesthesia. The quality of oral intake was also unaffected by dexamethasone at 24 hr. Dexamethasone did produce a significant reduction in postdischarge vomiting, beyond the incidence found with ondansetron alone. RésuméObjectif La dexame´thasone diminue la morbiditeṕ ostope´ratoire apre`s une intervention chirurgicale pour ade´no-amygdalectomie, strabisme et extraction de la troisie`me molaire. Nous avons formule´l'hypothe`se que la dexame´thasone pouvait diminuer la douleur et d'autres morbidite´s chez des enfants subissant une chirurgie dentaire jusqu'a`24 heures apre`s l'intervention. Méthodes Une e´tude randomise´e, contrôle´e, a`triple insu a e´te´mene´e chez 200 enfants subissant une restauration

Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy

“…dexamethasone at a dose of 0.3 mg kg 21 did not reduce postoperative pain in dental rehabilitation. 38 Therefore, 0.1 mg kg 21 of systemic dexamethasone does not seem to provide clinically relevant analgesia in children. Although the effect of caudal dexamethasone through systemic absorption on analgesia cannot be excluded in this design, our study clearly demonstrates that caudal dexamethasone can provide clinically relevant analgesia even at a low dose in children undergoing orchiopexy.…”

Corticosteroids or Not for Postoperative Nausea: A Double-Blinded Randomized Study

“…Premedication with corticosteroids has been used extensively in PONV prophylaxis. Such medication has been reported to be of value in several different types of surgery [2,15,16,17]. Our previous ERAS protocol included parenterally administered corticosteroids since 10 years, and was based on literature studies as well as one study from our own unit [8] The experience with preoperative corticosteroids in bariatric surgery is however limited [2,5].…”

Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: A systematic review and meta‐analysis

“…As already known, dexamethasone is widely used for prevention of postoperative vomiting in children undergoing general anesthesia . Additionally, patients who received dexamethasone showed an advance to soft/solid diet and decreased pain after tonsillectomy .…”

“…6 As already known, dexamethasone is widely used for prevention of postoperative vomiting in children undergoing general anesthesia. [7][8][9] Additionally, patients who received dexamethasone showed an advance to soft/solid diet and decreased pain after tonsillectomy. 10 Steroids are widely studied for treating chronic pain, such as postlaminectomy syndrome, postherpetic or posttraumatic neuralgia, diabetic neuropathy, and myofascial pain.…”