Effect of intermediate dose dexamethasone on post-operative pain in lumbar spine surgery: A randomized, triple-blind, placebo-controlled trial

Wittayapairoj, Aumjit; Wittayapairoj, Kriangkrai; Kulawong, Atiporn; Huntula, Yuwadee

doi:10.1016/j.aja.2017.08.001

Cited by 14 publications

(13 citation statements)

References 27 publications

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“…Next, Then, according to the inclusion criteria, 209 articles were removed after reading the titles and abstracts. Finally, we included 8 RCTs [ 14 – 21 ] with 918 patients (glucocorticoid group = 449, control group = 469, Fig. 1 ) in this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Intravenous glucocorticoid for pain control after spinal fusion

Wang

Shi

et al. 2018

Medicine

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Objective:Postoperative pain was a common symptom after spinal surgery. This meta-analysis aimed to assess whether intravenous glucocorticoids has a beneficial role in reducing pain in patients following spinal fusion.Methods:We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Google databases, from inception to March 2, 2018. Randomized controlled trials (RCTs) that comparing intravenous glucocorticoids with control treatment for spinal fusion were included. A meta-analysis was performed to generate pooled risk ratio (RR) and weighted mean difference with corresponding 95% confidence interval (CI) for discontinuous outcomes (the occurrence of nausea and infection) and continuous outcomes (visual analog scale [VAS] at 12, 24, and 48 h; total morphine consumption; and the length of hospital stay), respectively.Results:Eight clinical trials involving 918 patients (glucocorticoid group = 449, control group = 469) were finally included in this meta-analysis. Compared with control, intravenous glucocorticoids had significantly reduced VAS at 12, 24, and 48 hours with statistically significance (P < .05). Intravenous glucocorticoids can decrease the occurrence of nausea (RR = 0.42, 95% CI 0.29–0.62, P = .000; I2 = 0.0%) and the length of hospital stay. No difference was noticed in the occurrence of infection between glucocorticoids intravenous and control (P > .05).Conclusion:Existing evidence indicated that intravenous glucocorticoids have a beneficial role in decreasing early pain and the occurrence of nausea after spinal fusion surgery. In consideration of the limitation in current meta-analysis, more high-quality RCTs were needed to identify the optimal dose of glucocorticoids in spinal fusion patients.

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Section: Resultsmentioning

confidence: 99%

Intravenous glucocorticoid for pain control after spinal fusion

Wang

Shi

et al. 2018

Medicine

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“…The basic characteristics of all articles were showed in Table 1. The 8 studies published ranging from to 2019 totally involved 958 cases, 431 cases were in the dexamethasone group and 527 cases in the control group [11,[14][15][16][17][18][19][20]. Studies were performed in different countries, including Iran, Thailand, Canada, Germany, Denmark, France, Korea.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…And all studies were achieved by double blinding or triple blinding. Six studies provided the complete outcome [11,14,15,17,19,20]. A percentage was used to present the risk of each bias item across all included studies, which represented the different levels of risk of bias for each item (Fig 3).…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

“…Pooled results suggested that VAS scores at 24 hours of movement in control groups was signi cantly higher than in dexamethasone groups (SMD = -0.44, 95% CI: -0.67 to -0.21, P < 0.001). And four studies [11,15,17,20] provided the outcomes of VAS scores at 24 hours of rest after the spine surgery. There was no signi cant heterogeneity of the studies (x 2 = 1.21, df = 3, I 2 = 0.0%, P = 0.750); Thus, xedeffect model was applied.…”

Section: Primary Outcomes Vas Scores At 24 Hoursmentioning

confidence: 99%

“…Six studies [11,14,15,17,19,20]provided the occurrence of PONV after the spine surgery. There was no signi cant heterogeneity of the studies (x 2 = 14.73, df = 5, I 2 = 66%, P = 0.012); Thus, xed-effect model was applied.…”

Section: The Occurrence Of Postoperative Nausea and Vomitingmentioning

confidence: 99%

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The Efficiency And Safety Of Dexamethasone For Pain Relief Followed Lumbar Decompression And Fusion: A Systematic Review And Meta-Analysis

Chen

Yang

et al. 2020

Preprint

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Background: This meta-analysis was to evaluate the safety and efficiency of dexamethasone for pain relief followed lumbar decompression and fusion.Methods: Two reviewers have independently searched 3 electronic databases (PubMed, EMBASE and Cochrane Library) up to Jun, 2019 without restrictions on language and publication. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary. The results of dichotomous outcomes were expressed as relative risks (RRs) with a 95% confidence intervals (CIs). For continuous variable, mean and standard difference (SD) were applied for assessment. Meta-analysis was performed using Stata 12.0 software.Results: Seven RCTs and one retrospective study including 958 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences between groups in terms of visual analogue scale (VAS) scores at 24 hours of movement (SMD=0.44, 95% CI: 0.67 to 0.21, P < 0.001). Dexamethasone group was associated with a lower opioids consumption at 24 hours (SMD=0.601, 95% CI: 0.93 to 0.28, P < 0.001), less occurrence of nausea and vomiting (RR=0.52, 95% CI: 0.40 to 0.67, P < 0.001), shorter length of hospital stay (SMD = 0.207, 95% CI: 0.396 to 0.017, P = 0.003).Conclusion: In our meta-analysis of 8 reliable studies, we found that intravenous dexamethasone could significantly reduce postoperative pain scores and opioids consumption within the 24 hours followed lumbar decompression and fusion. Furthermore, patients could gain functional exercise early and the length of stay in hospital was significantly shorten. More researches were needed to confirm these conclusions.

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Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis

Weibel

Rücker

Eberhart

et al. 2020

Cochrane Database of Systematic Reviews

110

133

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Effect of intermediate dose dexamethasone on post-operative pain in lumbar spine surgery: A randomized, triple-blind, placebo-controlled trial

Abstract: A single, intermediate dose of dexamethasone before anesthetic induction could minimally decrease post-operative morphine consumption within 48 h after lumbar decompressive laminectomy without any effect on the pain score.

Cited by 14 publications

References 27 publications

Intravenous glucocorticoid for pain control after spinal fusion

Intravenous glucocorticoid for pain control after spinal fusion

The Efficiency And Safety Of Dexamethasone For Pain Relief Followed Lumbar Decompression And Fusion: A Systematic Review And Meta-Analysis

Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis

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