Efficacy and Safety of Steroid Use for Postoperative Pain Relief

Abstract

Despite the availability of various analgesic regimens, patient surveys have indicated that moderate-to-severe postoperative pain is still poorly managed. The use of corticosteroids for postoperative pain relief, although popular, has yet to gain wider acceptance because of concerns over side effects, in particular adrenal suppression, osteonecrosis, impaired wound-healing, and concerns about efficacy. The medical literature provides evidence that should substantially decrease these concerns with regard to low and short-dose applications. The results of randomized trials have shown low, short-dose corticosteroid regimens to be safe and effective for reducing postoperative pain. There is strong, grade-A evidence supporting the use of corticosteroids in multimodal analgesia protocols to contribute to the postoperative recovery of the patient by minimizing opioid doses and therefore side effects. However, the optimal mode, dose, and timing of administration remain unclear.

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

“…Our findings agree with those of previous small series [15,36,38,40] and reviews of numerous perioperative settings [19,21,22,46] that found no association between corticosteroid use and increased risk for postoperative wound infection. Furthermore, studies using higher corticosteroid doses than that used in our study showed no increase in postoperative wound infection after major orthopaedic surgeries [1,5,19,25,46]. The rate of periprosthetic joint infections after primary TKA at our institute was 0.6% (8/1323 patients) between 2006 and 2009 [50], and we have maintained the same operating room environment, surgical scrub, skin preparation, and antibiotic prophylactic protocol since 2003.…”

“…However, all of them completed the 6-month followup visit and all were contacted by telephone to assess the presence of a periprosthetic joint infection at 1 year after TKA. Fourth, despite the numerous potential side effects associated with corticosteroids [22,45,46], we assessed only the incidence of postoperative wound complications because they are the most serious complication associated with TKA. Although previous studies using higher doses of corticosteroids reported no increase in other potential side effects [22,46], additional study is necessary to investigate potential side effects of corticosteroid use after TKA.…”

“…Fourth, despite the numerous potential side effects associated with corticosteroids [22,45,46], we assessed only the incidence of postoperative wound complications because they are the most serious complication associated with TKA. Although previous studies using higher doses of corticosteroids reported no increase in other potential side effects [22,46], additional study is necessary to investigate potential side effects of corticosteroid use after TKA. Finally, this study had limited power to detect a subtle difference in postoperative wound complications because the sample size of the study was determined based on the primary efficacy outcome, that is, the incidence of PONV.…”

“…Corticosteroids have potent antiinflammatory and antiemetic effects and have been widely used in various perioperative settings such as abdominal, cardiac, ear-nosethroat, gynecologic, and plastic surgery for reducing postoperative pain and PONV [9,19,21,22,46]. Previous studies have found that perioperative use of single, lowdose corticosteroids significantly decreased inflammatory markers after TKA [23,24,49].…”

Betamethasone in Prevention of Postoperative Nausea and Vomiting Following Breast Surgery

“…Dexamethasone, with an equipotent anti-inflammatory and glucocorticoid effect as betamethasone [10], has been shown to cause reduction in the incidence of PONV with a plateau effect at 8 mg [11], although other studies have demonstrated significant effects with lower doses [12].…”