title: Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis.
abstract: BACKGROUND
  The analgesic efficacy and adverse effects of a single perioperative dose of dexamethasone are unclear. We performed a systematic review to evaluate the impact of a single i.v. dose of dexamethasone on postoperative pain and explore adverse events associated with this treatment.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for randomized, controlled studies that compared dexamethasone vs placebo or an antiemetic in adult patients undergoing general anaesthesia and reported pain outcomes.
  
  
  RESULTS
  Forty-five studies involving 5796 patients receiving dexamethasone 1.25-20 mg were included. Patients receiving dexamethasone had lower pain scores at 2 h {mean difference (MD) -0.49 [95% confidence interval (CI): -0.83, -0.15]} and 24 h [MD -0.48 (95% CI: -0.62, -0.35)] after surgery. Dexamethasone-treated patients used less opioids at 2 h [MD -0.87 mg morphine equivalents (95% CI: -1.40 to -0.33)] and 24 h [MD -2.33 mg morphine equivalents (95% CI: -4.39, -0.26)], required less rescue analgesia for intolerable pain [relative risk 0.80 (95% CI: 0.69, 0.93)], had longer time to first dose of analgesic [MD 12.06 min (95% CI: 0.80, 23.32)], and shorter stays in the post-anaesthesia care unit [MD -5.32 min (95% CI: -10.49 to -0.15)]. There was no dose-response with regard to the opioid-sparing effect. There was no increase in infection or delayed wound healing with dexamethasone, but blood glucose levels were higher at 24 h [MD 0.39 mmol litre(-1) (95% CI: 0.04, 0.74)].
  
  
  CONCLUSIONS
  A single i.v. perioperative dose of dexamethasone had small but statistically significant analgesic benefits.
authors.affiliation: Department of Anesthesiology,  Duke University Medical Center, Box 3094, Durham, NC 27710,  USA.
authors.forename: N H
authors.initials: NH
authors.lastname: Waldron
authors.forename: C A
authors.initials: CA
authors.lastname: Jones
authors.forename: T J
authors.initials: TJ
authors.lastname: Gan
authors.forename: T K
authors.initials: TK
authors.lastname: Allen
authors.forename: A S
authors.initials: AS
authors.lastname: Habib
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016001:Confidence Intervals; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone