Dexamethasone for pain after outpatient shoulder surgery: a randomised, double‐blind, placebo‐controlled trial

Bjørnholdt, Karen Toftdahl; Mønsted, P. N.; Søballe, Kjeld; Nikolajsen, Lone

doi:10.1111/aas.12333

Cited by 18 publications

(13 citation statements)

References 26 publications

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“…It is possible that dexamethasone at this dose had an effect because it was given before surgery: the meta‐analysis suggested that pre‐operative administration was more effective than intra‐operative administration. An intravenous dexamethasone dose of 40 mg had similar effects to a dose of 8 mg on postoperative pain or analgesic consumption after arthroscopic shoulder surgery, suggesting an upper limit to a dose–response relationship .…”

Section: Discussionmentioning

confidence: 87%

A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery

et al. 2015

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SummaryWe recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0

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Section: Discussionmentioning

confidence: 87%

A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery

et al. 2015

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“…Six of the included studies used a low dose (4–5 mg) of dexamethasone . Twenty‐six included studies used an intermediate dose of dexamethasone (8–10 mg) . Seven groups studied a high dose of dexamethasone (12–20 mg) .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies were conducted with an open‐label control group, which received a placebo and two studies were conducted in a blinded fashion; however, the control group did not receive a placebo . All other studies were blinded and were conducted with a placebo group . In 20 studies, participants with diabetes were eligible for inclusion in their respective studies .…”

Section: Resultsmentioning

confidence: 99%

Adverse side‐effects of dexamethasone in surgical patients – an abridged Cochrane systematic review

Polderman

Farhang-Razi

Dieren³

et al. 2019

Anaesthesia

100

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In the peri-operative period, dexamethasone is widely and effectively used for prophylaxis of postoperative nausea and vomiting. The objective of this meta-analysis was to assess the adverse effects of an incidental steroid load of dexamethasone in adult surgical patients. We searched in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Web of Science for randomised controlled trials comparing an incidental steroid load of dexamethasone with a control intervention in adult patients undergoing surgery. Two review authors independently screened studies for eligibility, extracted data and assessed all included studies for bias. Our primary outcomes were postoperative systemic or wound infection, delayed wound healing and glycaemic response within 24 h. We included 37 studies in this meta-analysis. The pooled results found no evidence that dexamethasone increased the risk of a postoperative wound infection, Peto OR (95%CI) 1.01 (0.80-1.27); 4603 participants, 26 studies; I² = 32%; moderate-quality evidence. Whether dexamethasone influenced wound healing was unclear due to the large confidence intervals, Peto OR (95%CI) 0.99 (0.28-3.43); 1072 participants, 8 studies; I² = 0%; low-quality evidence. Dexamethasone produced a mild increase in glucose levels among participants without diabetes during the first 12 h after surgery, mean difference (95%CI) 0.7 mmol.l À1 (0.3-1.2) 10 studies; 595 participants; I² = 50%; low-quality evidence. This article is an abridged version of a Cochrane Review.

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“…Intravenous and perineural administration seems to be equivalent in concern to the adjuvant analgesic effect on ISNB [ 61 ]. If the dose is increased the analgesic effect is not prolonged [ 62 ]. Low doses of perineural dexamethasone, like 4 mg, increases the duration of ropivacaine 0,75%.…”

Section: Anesthetic Management Of the Patient With Chronic Shoulder Imentioning

confidence: 99%

Anesthesia and Analgesia in the Patient with an Unstable Shoulder

Bambaren¹,

Dominguez²,

Martı́n³

et al. 2017

TOORTHJ

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Introduction:The patient with an unstable shoulder represents a challenge for the anesthesiologist. Most patients will be young individuals in good health but both shoulder dislocation reduction, a procedure that is usually performed under specific analgesia in an urgent setting, and instability surgery anesthesia and postoperative management present certain peculiarities.Material and Methods:For the purpose of the article, 78 references including clinical trials and reviews were included. The review was organized considering the patient that presents an acute shoulder dislocation and the patient with chronic shoulder instability that requires surgery. In both cases the aspects like general or regional anesthesia, surgical positions and postoperative pain management were analyzed.Conclusion:The patient with an acutely dislocated shoulder is usually managed in the emergency room. Although reduction without analgesia is often performed in non-medical settings, an appropriate level of analgesia will ease the reduction procedure avoiding further complications. Intravenous analgesia and sedation is considered the gold standard but requires appropriate monitorization and airway control. Intraarticular local analgesic injection is considered also a safe and effective procedure. General anesthesia or nerve blocks can also be considered. The surgical management of the patient with shoulder instability requires a proper anesthetic management. This should start with an exhaustive preoperative evaluation that should be focused in identifying potential respiratory problems that might be complicated by local nerve blocks. Intraoperative management can be challenging, especially for patients operated in beach chair position, for the relationship with problems related to cerebral hypoperfusion, a situation related to hypotension events directly linked to patient positioning. Different nerve blocks will help attaining excellent analgesia both during and after the surgical procedure. An interescalene nerve block should be considered the best technique, but in certain cases, other blocks can be considered.

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Dexamethasone for pain after outpatient shoulder surgery: a randomised, double‐blind, placebo‐controlled trial

Abstract: 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.

Cited by 18 publications

References 26 publications

A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery

A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery

Adverse side‐effects of dexamethasone in surgical patients – an abridged Cochrane systematic review

Anesthesia and Analgesia in the Patient with an Unstable Shoulder

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