Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgery.
BACKGROUND
Dexamethasone 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.


METHODS
Sixty 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.


RESULTS
Twenty-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.


CONCLUSIONS
Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus.
Mattila
K
K
Department of Anesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, 00029 HUS Finland. kristiina.mattila@hus.fi
Kontinen
V K
VK
Kalso
E
E
Hynynen
M J
MJ
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000556:Ambulatory Surgical Procedures; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D000775:Anesthesia, Spinal; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006215:Hallux Valgus / Q000601:surgery; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy; D010098:Oxycodone / Q000008:administration & dosage* / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D000082:Acetaminophen; D003907:Dexamethasone; D010098:Oxycodone