• K Mattila, V K Kontinen, E Kalso, and M J Hynynen.
• Department of Anesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, 00029 HUS Finland. kristiina.mattila@hus.fi
• Acta Anaesthesiol Scand. 2010 Mar 1;54(3):268-76.

BackgroundDexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus.MethodsSixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented.ResultsTwenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0-165) mg in the dexamethasone group and 78 (15-175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0-1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0-1, and significantly less nausea on POD 1. On PODs 2-3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ - in both groups 81% would have chosen the same medication again.ConclusionOral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus.

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