title: The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery.
abstract: BACKGROUND
  Glucocorticoids provide analgesia. In this study, we evaluated the effects of adding dexamethasone to a multimodal postoperative analgesic regimen, including a long-acting nonsteroidal antiinflammatory drug.
  
  
  METHODS
  One-hundred patients admitted for ambulatory breast cancer surgery were studied. They received paracetamol 2 g and rofecoxib 50 mg orally 1 h before start of general anesthesia with propofol and remifentanil. The patients were then randomized to receive, in a double-blind manner, either dexamethasone 16 mg IV or placebo. Both groups received fentanyl 1 mug/kg IV and 20-40 mL bupivacaine 2.5 mg/mL wound infiltration before the end of surgery.
  
  
  RESULTS
  There was no difference in pain scores or rescue medication between the groups during the first 4 h after surgery. After discharge, the median pain score during coughing or shoulder movement was 3 on a 0-10 scale in patients receiving placebo, and 1 in the patients receiving dexamethasone, which did not reach statistical significance (P = 0.06). From 24 to 72 h, the median pain with coughing or shoulder movement in patients receiving placebo was 2, and 1 in patients receiving dexamethasone, which did reach statistical significance (P < 0.05). Forty percent of patients receiving dexamethasone were pain free from 4 to 24 h, compared with 24% of patients receiving placebo, a difference that did not reach statistical significance (P = 0.09). Similarly, 46% of patients receiving dexamethasone were pain free from 24 to 72 h, compared with 28% of patients receiving placebo (P = 0.06). More patients had slept poorly on the first night in the dexamethasone group than in the control group, 68% vs 44%, (P < 0.05).
  
  
  CONCLUSIONS
  Dexamethasone 16 mg provides prolonged postoperative analgesia from 24 to 72 h after surgery when added to a multimodal regimen including nonsteroidal antiinflammatory drug (rofecoxib).
authors.affiliation: Department of Anaesthesia, Ullevaal University Hospital, Oslo, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Hval
authors.forename: Hval
authors.initials: H
authors.lastname: Kjetil
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Thagaard
authors.forename: Thagaard K
authors.initials: TK
authors.lastname: Sem
authors.forename: Ellen
authors.initials: E
authors.lastname: Schlichting
authors.forename: Schlichting
authors.initials: S
authors.lastname: Ellen
authors.forename: Johan
authors.initials: J
authors.lastname: Raeder
authors.forename: Raeder
authors.initials: R
authors.lastname: Johan
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007783:Lactones / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013450:Sulfones / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib; D003907:Dexamethasone