title: Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. g-jr@northwestern.edu
authors.forename: Gildàsio S
authors.initials: GS
authors.lastname: De Oliveira
authors.forename: Marcela D
authors.initials: MD
authors.lastname: Almeida
authors.forename: Honorio T
authors.initials: HT
authors.lastname: Benzon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009068:Movement; D010149:Postoperative Pain / Q000188:drug therapy*; D010351:Patient Discharge; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012146:Rest; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone