Another Reason to Give Decadron

[BLADEMDA]

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Anesthesiology:
September 2011 - Volume 115 - Issue 3 - p 575–588
doi: 10.1097/ALN.0b013e31822a24c2
Pain Medicine

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

De Oliveira, Gildàsio S. Jr M.D.*; Almeida, Marcela D. M.D.†; Benzon, Honorio T. M.D.‡; McCarthy, Robert J. Pharm.D.§

Abstract



Background: Dexamethasone is frequently administered in the perioperative period to reduce postoperative nausea and vomiting. In contrast, the analgesic effects of dexamethasone are not well defined. The authors performed a meta-analysis to evaluate the dose-dependent analgesic effects of perioperative dexamethasone.
Methods: We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effect model. Effects of dexamethasone dose were evaluated by pooling studies into three dosage groups: low (less than 0.1 mg/kg), intermediate (0.11–0.2 mg/kg) and high (≥0.21 mg/kg).
Results: Twenty-four randomized clinical trials with 2,751 subjects were included. The mean (95% CI) combined effects favored dexamethasone over placebo for pain at rest (≤4 h, −0.32 [0.47 to −0.18], 24 h, −0.49 [−0.67 to −0.31]) and with movement (≤ 4 h, −0.64 [−0.86 to −0.41], 24 h, −0.47 [−0.71 to −0.24]). Opioid consumption was decreased to a similar extent with moderate −0.82 (−1.30 to −0.42) and high −0.85 (−1.24 to −0.46) dexamethasone, but not decreased with low-dose dexamethasone −0.18 (−0.39–0.03). No increase in analgesic effectiveness or reduction in opioid use could be demonstrated between the high- and intermediate-dose dexamethasone. Preoperative administration of dexamethasone appears to produce a more consistent analgesic effect compared with intraoperative administration.
Conclusion: 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.

 

[epidural man]

Anesthesiology:
September 2011 - Volume 115 - Issue 3 - p 575–588
doi: 10.1097/ALN.0b013e31822a24c2
Pain Medicine

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

De Oliveira, Gildàsio S. Jr M.D.*; Almeida, Marcela D. M.D.†; Benzon, Honorio T. M.D.‡; McCarthy, Robert J. Pharm.D.§

Abstract



Background: Dexamethasone is frequently administered in the perioperative period to reduce postoperative nausea and vomiting. In contrast, the analgesic effects of dexamethasone are not well defined. The authors performed a meta-analysis to evaluate the dose-dependent analgesic effects of perioperative dexamethasone.
Methods: We followed the PRISMA statement guidelines. A wide search was performed to identify randomized controlled trials that evaluated the effects of a single dose systemic dexamethasone on postoperative pain and opioid consumption. Meta-analysis was performed using a random-effect model. Effects of dexamethasone dose were evaluated by pooling studies into three dosage groups: low (less than 0.1 mg/kg), intermediate (0.11–0.2 mg/kg) and high (≥0.21 mg/kg).
Results: Twenty-four randomized clinical trials with 2,751 subjects were included. The mean (95% CI) combined effects favored dexamethasone over placebo for pain at rest (≤4 h, −0.32 [0.47 to −0.18], 24 h, −0.49 [−0.67 to −0.31]) and with movement (≤ 4 h, −0.64 [−0.86 to −0.41], 24 h, −0.47 [−0.71 to −0.24]). Opioid consumption was decreased to a similar extent with moderate −0.82 (−1.30 to −0.42) and high −0.85 (−1.24 to −0.46) dexamethasone, but not decreased with low-dose dexamethasone −0.18 (−0.39–0.03). No increase in analgesic effectiveness or reduction in opioid use could be demonstrated between the high- and intermediate-dose dexamethasone. Preoperative administration of dexamethasone appears to produce a more consistent analgesic effect compared with intraoperative administration.
Conclusion: 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.

Blade, I must say...you are really enjoying this latest issue of Anesthesiology. 🙂

 

[sevoflurane]

I give Dexa to just 'bout everybody. Goes in with my induction meds.

What patients, if any, do you avoid Dexa?

I usually avoid it in poorly contrlolled Diabetics.

How 'bout those with very low white counts 2/2 chemo or recent bone marrow tx? Immunosupressed....?

Or the septic guy with a white count of 30k?

How much are you giving? 4mg? 6mg?

Kids I dose on weight.