Epidural Dexamethasone for Acute Postoperative Pain Management: A Systematic Review with Meta-Analysis

Abstract

Aim: To study the effect of epidural dexamethasone in postoperative pain management. Methods: Random-effects meta-analysis was conducted in RevMan 5.4. Results: We included nine randomized-controlled trials (RCT) with 657 patients. Dexamethasone demonstrated longer analgesia duration (mean difference 266.18 minutes, 95% CI [3.21,529.14]; p 0.05), lower incidence of nausea and vomiting during the first postoperative day (risk ratio 0.36, 95% CI [0.18,0.71]; p 0.004), and lower antiemetic requirements (risk ratio 0.33, 95% CI [0.14,0.79]; p 0.01). No difference in pain reduction and the length of hospital stay was observed between the groups. Conclusion: Dexamethasone was associated with a longer analgesic effect, a lower number of patients requiring antiemetics, and lower incidences of nausea and vomiting.

Plain language summary

Pain after major surgeries can be severe. Sometimes patients need to take additional analgesics after surgery. Dexamethasone is a steroid, which can potentially reduce this pain and the need for pain-relieving medications. We wanted to know whether dexamethasone reduces the use of analgesics, nausea and vomiting after surgeries, pain, or length of hospital stay.

We found nine articles with 657 patients, which compared dexamethasone with a placebo. According to our analysis, dexamethasone does not decrease pain or length of hospital stay. However, surgery patients can benefit from a decrease in nausea and vomiting and the need for medications for these side effects.

Due to the small number of participants, our conclusions should be taken with caution.

Tweetable abstract

Meta-analysis of nine RCTs with 657 patients showed that dexamethasone reduces the incidence of postoperative nausea and vomiting, but not postoperative pain or length of hospital stay.

Keywords::

• corticosteroids
• epidural dexamethasone
• nausea
• pain control
• postoperative pain
• vomiting

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2022-0065

Author contributions

D Viderman: methodology, supervision, writing - original draft, writing - review & editing, funding acquisition; K Tapinova: data collection, writing - original draft, writing - review & editing; F Nabidollayeva: data collection, statistical analysis; Y Abdildin: methodology, supervision, statistical analysis, writing - review & editing, funding acquisition.

Financial & competing interests disclosure

This work was supported in part by Nazarbayev University Faculty Development Competitive Research Grants No. 11022021FD2906 and SOM2021005 (021220FD2851). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

This work was supported in part by Nazarbayev University Faculty Development Competitive Research Grants No. 11022021FD2906 and SOM2021005 (021220FD2851). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.