Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain

Oliveira, Gildàsio S. De; Almeida, Marcela; Benzon, Honorio T.; McCarthy, Robert J.

doi:10.1097/aln.0b013e31822a24c2

Cited by 661 publications

(474 citation statements)

References 56 publications

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“…This includes the beneficial effect of epidural steroid after lumbar discectomy [18] and from locally applied methylprednisolone in patients undergoing mixed lumbar surgical interventions [19]. The efficacy of glucocorticoids as part of multimodal postoperative pain treatment in different surgical procedures has recently been reviewed [20] demonstrating reductions in both pain scores and morphine consumption. Likewise, Lunn et al [21] showed that IV methylprednisolone 125 mg after total knee arthroplasty improved analgesia and promoted recovery.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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Section: Discussionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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“…All patients received perioperative dexamethasone and NSAIDs as part of multimodal analgesia and postoperative nauseavomiting prophylaxis. These are commonly used and recommended agents [1,5,6] but may have diminished the magnitude of inflammatory and pain responses in all patients due to their antiinflammatory nature [12]. All patients received aspirin as standard deep venous thrombosis prophylaxis, which again may have diminished inflammatory and pain responses in all patients.…”

Section: Discussionmentioning

confidence: 99%

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Motaghedi

Bae

Memtsoudis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The prevalence of obesity is increasing, and obesity often leads to degenerative joint disease requiring total hip arthroplasty (THA). Obesity is a proinflammatory state associated with an increase in chronic, low-grade inflammatory response. As such, it may augment the postoperative inflammatory response, which has been associated with postoperative pain and complications.Questions/purposes We determined whether severity of obesity was associated with (1) severity of inflammatory response, as measured by the in vivo circulating levels of cytokines and ex vivo functional reactivity of mononuclear blood cells, and (2) severity of pain, as measured by verbal pain scores and analgesic consumption, in the first 24 hours after THA. Methods We studied 60 patients (20 normal weight, 20 overweight, 20 obese) undergoing elective primary unilateral THA in this prospective cross-sectional study. Blood samples were collected for C-reactive protein and cytokine levels, including IL-1b, IL-2, IL-6, IL-8, and tumor necrosis factor a (TNF-a), from patients before and 24 hours after surgery. Cytokine response of whole blood was evaluated ex vivo with or without two standard activators, phorbol-12-myristate-13-acetate and lipopolysaccharide, using standardized blood sample from patients at 24 hours. These standard immune activators are implicated in the inflammatory response to gram-negative infection, translocation of microbial products, pathophysiology of septic shock syndrome in human, and tumor promotion. Pain response was gauged using verbal pain scores (on a 0-to 10-point scale, where 0 = no pain and 10 = worst pain) at rest and with activity at 24 hours after surgery and analgesic

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“…Corticosteroids have potent antiinflammatory and antiemetic effects and have been widely used in various perioperative settings such as abdominal, cardiac, ear-nosethroat, gynecologic, and plastic surgery for reducing postoperative pain and PONV [9,19,21,22,46]. Previous studies have found that perioperative use of single, lowdose corticosteroids significantly decreased inflammatory markers after TKA [23,24,49].…”

Section: Introductionmentioning

confidence: 99%

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

Koh

Chang

Lee

et al. 2013

Clinical Orthopaedics &Amp; Related Research

118

147

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Background Dexamethasone is a potent analgesic and antiemetic. However, the benefit of dexamethasone after TKA is unclear, as is the efficacy in a current multimodal regime. Questions/purposes We determined (1) whether the addition of dexamethasone to a protocol including ramosetron further reduces postoperative emesis compared with ramosetron alone; (2) whether it reduces postoperative pain; and (3) whether it increases the risk for wound complications in a current multimodal regime after TKA. Methods We randomized 269 patients undergoing TKAs to receive dexamethasone (10 mg) 1 hour before surgery and ramosetron immediately after surgery (Dexa-Ra group, n = 135), or ramosetron alone (Ra group, n = 134). We recorded the incidence of postoperative nausea and vomiting (PONV), severity of nausea, incidence of antiemetic requirement, complete response, pain level, and opioid consumption. Patients were assessed 0 to 6, 6 to 24, 24 to 48, and 48 to 72 hours postoperatively. In addition, patients were evaluated for wound complications and periprosthetic joint infections at a minimum of 1 year after surgery. Results The Dexa-Ra group had a lower incidence of PONV during the entire 72-hour evaluation period and experienced less severe nausea for the first 6 hours after TKA, although not between 6 to 72 hours.

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Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain

Abstract: Dexamethasone at doses more than 0.1 mg/kg is an effective adjunct in multimodal strategies to reduce postoperative pain and opioid consumption after surgery. The preoperative administration of the drug produces less variation of effects on pain outcomes.

Cited by 661 publications

References 56 publications

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

Association of Obesity With Inflammation and Pain After Total Hip Arthroplasty

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

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