Perioperative Dexamethasone and the Development of Chronic Postmastectomy Pain: A Single-Center Observational Cohort Study.
OBJECTIVE
Perioperative modulation of the surgical inflammatory response has been hypothesized as a viable pharmacological preventive target for the development of chronic pain after surgery. The objective of the current investigation was to evaluate an association between intravenous dexamethasone 4 to 20 mg on the day of surgery with self-reported pain in the breast or axilla 3 months or more after mastectomy.


METHODS
The study was a secondary data analysis of a prospective cohort investigation. Subjects who have undergone mastectomy surgery were evaluated at least 3 months after the surgical procedure for the presence of chronic postsurgical pain using validated pain questionnaires. Binary logistic regression analysis was used to determine the odds of development of chronic postsurgical pain in subjects who did and did not receive perioperative dexamethasone.


RESULTS
Three hundred ten patients were included in the study. Fifty-two patients (17%) met the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) criteria for chronic pain in the breast and/or axillary region. Two hundred eleven (68%) of 310 subjects received perioperative dexamethasone on doses varying from 4 to 20 mg. The incidence of chronic pain in the mastectomy group who received perioperative dexamethasone was not different, 15 (15.2%) of 84 compared with 37 (17.5%) of 211 in the group who did not receive perioperative dexamethasone, difference -2% (95% confidence interval, -10 to 7; P = 0.75).


CONCLUSIONS
Perioperative dexamethasone is not associated with a reduction in the incidence and/or severity of chronic postmastectomy pain. In addition, we did not detect a dose-response effect of dexamethasone on the incidence of chronic postsurgical pain.
From the *Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and †Department of Outcomes Research, Cleveland Clinic, Cleveland, OH.
Gildasio S
GS
de Oliveira
Jane M
JM
Bialek
Alparslan
A
Turan
Robert J
RJ
McCarthy
Daniel I
DI
Sessler
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015331:Cohort Studies; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008408:Mastectomy / Q000009:adverse effects* / Q000639:trends; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone