Preoperative IV dexamethasone reduces pain after arthroscopic shoulder surgery.

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• K T Bjørnholdt, P N Mønsted, K Søballe, and L Nikolajsen.
• Department of Orthopaedics, Horsens Regional Hospital, Horsens, Denmark.
• Acta Anaesthesiol Scand. 2014 Jul 1;58(6):751-8.

BackgroundDexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg.MethodsA randomised, double-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8) or placebo (D0) before surgery. The primary outcome was pain intensity 8 h after surgery rated on a numeric rating scale of 0 to 10. Secondary outcomes were pain intensity, analgesic consumption and side effects during the first 3 days after surgery.ResultsData from 73 patients were available for analysis: (D40: 25, D8: 26, D0: 22 patients). Eight hours after surgery, pain intensity were: [median (interquartile range)] group D40: 2 (1-4), group D8: 2.5 (1-5), group D0: 4 (2-7). There was no significant difference in pain intensity between group D40 and D8 after 8 h (P = 0.46) or at any other time. When comparing all three groups, a statistically significant dose-response relationship was seen for present, average and worst pain intensity after 8 h and on the following morning. No differences were found in analgesic consumption. No serious side effects were observed.ConclusionAlthough our data supported a dose-response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery.© 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

This article appears in the collection: Dexamethasone for all sorts of things.

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