Dexamethasone for pain after outpatient shoulder surgery: a randomised, double-blind, placebo-controlled trial.
BACKGROUND
Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg.


METHODS
A randomised, double-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8) or placebo (D0) before surgery. The primary outcome was pain intensity 8 h after surgery rated on a numeric rating scale of 0 to 10. Secondary outcomes were pain intensity, analgesic consumption and side effects during the first 3 days after surgery.


RESULTS
Data from 73 patients were available for analysis: (D40: 25, D8: 26, D0: 22 patients). Eight hours after surgery, pain intensity were: [median (interquartile range)] group D40: 2 (1-4), group D8: 2.5 (1-5), group D0: 4 (2-7). There was no significant difference in pain intensity between group D40 and D8 after 8 h (P = 0.46) or at any other time. When comparing all three groups, a statistically significant dose-response relationship was seen for present, average and worst pain intensity after 8 h and on the following morning. No differences were found in analgesic consumption. No serious side effects were observed.


CONCLUSIONS
Although our data supported a dose-response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery.
Department of Orthopaedics, Horsens Regional Hospital, Horsens, Denmark.
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Bjørnholdt
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Mønsted
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Søballe
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Nikolajsen
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000173:Acromioclavicular Joint / Q000601:surgery*; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D019299:Decompression, Surgical; D003907:Dexamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D011184:Postoperative Period; D011229:Preanesthetic Medication; D019534:Shoulder Impingement Syndrome / Q000601:surgery*; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; C004180:dexamethasone 21-phosphate; D000082:Acetaminophen; D014147:Tramadol; D003907:Dexamethasone; D007052:Ibuprofen