Perioperative Decadron for post op pain

[wtbcrna, MSN, DNP, CRNA]

Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials

Researchers conducted a meta-analysis of 24 randomized clinical trials, including 2,751 subjects, to evaluate the dose-dependent analgesic effects of perioperative dexamethasone. The trials included in the analysis evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Studies were pooled into three dosage groups: less than 0.1 mg/kg (low), 0.11-0.2 mg/kg (intermediate), and 0.21 mg/kg or more (high). The mean combined effects favored dexamethasone over placebo for pain at rest and with movement. Opioid consumption was similarly decreased with moderate and high dexamethasone, but not with low-dose dexamethasone. High-dose dexamethasone reduced movement pain 24 hours after surgery compared with the intermediate dose; however, the high dose showed no significant advantage in opioid-sparing effects, pain within four hours after surgery, and pain at rest 24 hours later. Preoperative administration of dexamethasone, compared with intraoperative administration, seemed to have a more consistent analgesic effect. The findings indicate that dexamethasone, given at doses more than 0.1 mg/kg, can help reduce postoperative pain and opioid consumption after surgery.

From "Perioperative Single Dose Systemic Dexamethasone for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials"

Anesthesiology (09/11) Vol. 115, No. 3, P. 575 De Oliveira, Gildasio S., Jr.; Almeida, Marcela D.; Benzon, Honorio T.; et al.

[wooh, BSN, RN]

Is it because it's decreasing the inflammation that the surgery creates? We see T&As and neck area I&Ds get the decadron intra-op all the time. I always thought primarily to reduce swelling since the airway area is where you'd least want it. Never thought about it for pain control too, although it makes sense. Very cool.

[tewdles, RN]

We use steroids bursts and doses not infrequently in attempt to control pain with hospice patients. It often achieves a level of control that is satisfactory to the patient/family.

[BCRNA]

Steroids give no direct pain relief. They can help prevent pain by decreasing inflammation (so it is indirect pain relief). Really depends on the source of pain. Surgeries associated with inflammation related pain can really benefit. I would not give a steroid just for pain relief, the potential side effects aren't worth it. Definitely a good tool though.

[wtbcrna, MSN, DNP, CRNA]

Steroids give no direct pain relief. They can help prevent pain by decreasing inflammation (so it is indirect pain relief). Really depends on the source of pain. Surgeries associated with inflammation related pain can really benefit. I would not give a steroid just for pain relief, the potential side effects aren't worth it. Definitely a good tool though.

Decadron has been shown to significantly reduce pain in certain operations (actually all surgeries are associated with inflammation so there is potential for Decadron to help in all surgeries) when given in doses at greater than 0.1mg/kg. Not all the surgeries in the review of literature showed significant reduction in pain though. The rate of serious adverse side effects after a single dose of dexamethasone (increase infection rates, suppression of the HPA axis, electrolyte disturbances etc.) are extremely unlikely (rare) when given as a single dose or

Personally, I have just switched from using 4mg of Decadron for PONV to 10mg which for most patients will give them a dose >0.1mg/kg. I also use Decadron in my PNBs/TAP blocks which dramatically increases length of duration by about 10+hrs in most cases.