Role of Dexamethasone in Peri-operative Anesthesia Management: A Review of Literature
DOI:
https://doi.org/10.17140/RPAOJ-2-114Keywords:
Dexamethasone, Peri-operative agent, AnesthesiaAbstract
Dexamethasone has been used widely in clinical specialties including anesthesia. It is regarded as one of the ideal peri-operative agent being readily available, cheap, anti-inflammatory agent, prevents and treats post-operative nausea and vomiting (PONV), promotes appetite, suppress inflammation, a good analgesic agent both as intravenously or as an adjuvant to peripheral nerve blocks, it provides a sense of well-being and is considered to have a good quality of recovery and early discharge in patients from anesthesia. Controversial role of dexamethasone in causing post-operative surgical site infections have been solved and overall adverse effects of dexamethasone are rare and its benefits out-weighs the risks involved. The author did a literature search in Google Scholar and PubMed databases (latest articles related to the role of dexamethasone in peri-operative period over a period of two years 2015-17).
References
DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017; 18: 357. doi: 10.1136/bmj.j1455
Vlok R, Melhuish TM, Chong C, Ryan T, White LD. Adjuncts to local anaesthetics in tonsillectomy: A systematic review and meta-analysis. J Anesth. 2017; 31(4): 608-616. doi: 10.1007/ s00540-017-2310-x
Sekhavat L, Davar R, Behdad S. Efficacy of prophylac-tic dexamethasone in prevention of postoperative nausea and vomiting. J Epidemiol Glob Health. 2015; 5(2): 175-179. doi: 10.1016/j.jegh.2014.07.004
Narayanappa AB, Gurulingaswamy S, Prabhakaraiah UN, Gurushanth SR, Sapare V, Goud N. Intravenous palonosetron compared with a combination of ramosetron and dexamethasone in preventing post operative nausea and vomiting in patients undergoing gynaecological surgeries under spinal anesthesia, a randomised study. Indian J Anaesth. 2017; 61: 144-149. doi: 10.4103/0019-5049.199851
Kurz A, Fleischmann E, Sessler DI, Buggy DJ, Apfel C, Akça O. Factorial Trial Investigators. Effects of supplemental oxygen and dexamethasone on surgical site infection: A factorial ran-domized trial‡. Br J Anaesth. 2015; 115: 434-443. doi: 10.1093/ bja/aev062
Bataille A, Letourneulx JF, Charmeau A, et al. Impact of a prophylactic combination of dexamethasone-ondansetron on postoperative nausea and vomiting in obese adult patients un-dergoing laparoscopic sleeve gastrectomy during closed-loop propofol-remifentanil anesthesia: A randomised double-blind placebo-controlled study. Eur J Anaesthesiol. 2016; 33(12): 898-905. doi: 10.1097/EJA.0000000000000427
Yang C, Jung SM, Bae YK, Park SJ. The effect of ketorolac and dexamethasone on the incidence of sore throat in women after thyroidectomy: A prospective double-blinded randomized trial. Korean J Anesthesiol. 2017; 70(1): 64-71. doi: 10.4097/ kjae.2017.70.1.64
Kamranmanesh M, Gharaei B. Is corticosteroid of no use for pediatric patients with common cold undergoing anesthesia? A randomized, double-blind, clinical trial. Anesth Pain Med. 2017; 7(3): e45166. doi: 10.5812/aapm.45166
Lim D, Ngeow WC. A comparative study on the efficacy of submucosal injection of dexamethasone versus methylpredniso-lone in reducing postoperative sequelae after third molar sur-gery. J Oral Maxillofac Surg. 2017; 75(11): 2278-2286. doi:
1016/j.joms.2017.05.033 10. So KY, Kim SH, Jung KT, Kim DW. Effect of dexametha-sone on the onset time and recovery profiles of cisatracurium. Korean J Anesthesiol. 2017; 70(2): 163-170. doi: 10.4097/ kjae.2017.70.2.163
Samona J, Cook C, Krupa K, et al. Effect of intraoperative dexamethasone on pain scores and narcotic consumption in pa-tients undergoing total knee arthroplasty. Orthop Surg. 2017; 9: 110-114. doi: 10.1111/os.12313
Jain R, Dua CK. Comparative analgesic efficacy of different doses of dexamethasone during infraumbilical surgery: A Ran-domized controlled trial. Anesth Essays Res. 2015; 9: 34-38. doi: 10.4103/0259-1162.150153
Srinivasan B, Karnawat R, Mohammed S, Chaudhary B, Ratnawat A, Kothari SK. Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial. Indian J Anaesth. 2016; 60: 948-954. doi: 10.4103/0019-5049.195489
Chalifoux F, Colin F, St-Pierre P, Godin N, Brulotte V. Low dose intravenous dexamethasone (4 mg and 10 mg) significantly prolongs the analgesic duration of single-shot interscalene block after arthroscopic shoulder surgery: A prospective randomized placebo-controlled study. Can J Anaesth. 2017; 64(3): 280-289. doi: 10.1007/s12630-016-0796-6
Kalappa S, Sridhar RB, Nagappa S. Comparing the efficacy of caudal with intravenous dexamethasone in the management of pain following lumbosacral spine) surgeries: A randomized double blinded controlled study. Anesth Essays Res. 2017; 11: 416-420. doi: 10.4103/0259-1162.194581
Shalu PS, Ghodki PS. To study the efficacy of intravenous dexamethasone in prolonging the duration of spinal anesthesia in elective cesarean section. Anesth Essays Res. 2017; 11(2): 321-325. doi: 10.4103/0259-1162.194537
Hong JM, Kim KH, Lee HJ, et al. Epidural dexamethasone influences postoperative analgesia after major abdominal sur-gery. Pain Physician. 2017; 20: 261-269.
Deo SP. Role of addition of dexamethasone to lignocaine 2% with adrenaline in dental nerve blocks for third molar surgery: A prospective randomized control trial. Ann Maxillofac Surg. 2016; 6(2): 260-266. doi: 10.4103/2231-0746.200341
Zhao WL, Ou XF, Liu J, Zhang WS. Perineural versus in-travenous dexamethasone as an adjuvant in regional anesthesia: A systematic review and meta-analysis. J Pain Res. 2017; 10: 1529-1543. doi: 10.2147/JPR.S138212
Razavizadeh MR, Fazel MR, Heydarian N, Atoof F. Epidural dexamethasone for postoperative analgesia in patients undergo-ing unilateral inguinal herniorrhaphy: A comparative study. Pain Res Manag. 2017: 7649458. doi: 10.1155/2017/7649458
Ribeiro KS, Ollapally A, Misquith J. Dexamethasone as an adjuvant to bupivacaine in supraclavicular brachial plexus block in paediatrics for post-operative analgesia. J Clin Diagn Res. 2016; 10(12): 1-4. doi: 10.7860/JCDR/2016/22089.8957
Akram M, Farooqi FM, Irshad M, Faraz Ul Hassan S, Awais SM. Role of addition of Dexamethasone and Ketorolac to ligno-caine intravenous regional anesthesia (Bier’s Block) to improve tourniquet tolerance and post-operative analgesia in hand and forearm surgery. J Pak Med Assoc. 2015; 65(11 Suppl 3): 128- 131.
Deshpande JP, Ghodki PS, Sardesai SP. The analgesic ef-ficacy of dexamethasone added to ropivacaine in transversus abdominis plane block for transabdominal hysterectomy under subarachnoid block. Anesth Essays Res. 2017; 11(2): 499-502. doi: 10.4103/aer.AER_22_17
Liu F, Zhang H, Zuo Y. Bilateral thoracic paravertebral block for immediate postoperative pain relief in the PACU: A prospec-tive, observational study. BMC Anesthesiol. 2017; 17: 89. doi: 10.1186/s12871-017-0378-3
Alzeftawy AE, Elsheikh NA. The effect of preemptive ankle block using ropivacaine and dexamethasone on postoperative analgesia in foot surgery. Anesth Essays Res. 2017; 11: 372-375. doi: 10.4103/0259-1162.206275
Jæger P, Grevstad U, Koscielniak-Nielsen ZJ, Sauter AR, Sørensen JK, Dahl JB. Does dexamethasone have a perineural mechanism of action? A paired, blinded, randomized, controlled study in healthy volunteers. Br J Anaesth. 2016; 117: 635-641. doi: 10.1093/bja/aew318
Chong MA, Berbenetz NM, Lin C, Singh S. Perineural versus intravenous dexamethasone as an adjuvant for peripheral nrve blocks: A systematic review and meta-analysis. Reg Anesth Pain Med. 2017; 42: 319-326. doi: 10.1097/AAP.0000000000000571
Moeen SM, Moeen AM. Intrathecal dexamethasone vs. me-peridine for prevention of shivering during transurethral pros-tatectomy: A randomized controlled trial. Acta Anaesthesiol Scand. 2017; 61(8): 749-757. doi: 10.1111/aas.12920
Karaman T, Karaman S, Doğru S, Tapar H, Şahin A, Süren M. Short-term and long-term effects of dexamethasone on cog-nitive dysfunction induced by sevoflurane in adult rats. Turk J Anaesthesiol Reanim. 2017; 45(3): 158-163. doi: 10.5152/ TJAR.2017.98624
Zanetti D, Di Berardino F, Nassif N, Redaelli De Zinis LO. Intratympanic steroid delivery by an indwelling catheter in re-fractory severe sudden sensorineural hearing loss. Auris Nasus Larynx. 2017; 13. doi: 10.1016/j.anl.2017.04.004
Corcoran T, Kasza J, Short TG, et al. ENIGMA-II investiga-tors. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: A propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX). Br J Anaesth. 2017; 118(2): 190-199. doi: 10.1093/bja/aew446
Richardson AB, Bala A, Wellman SS, Attarian DE, Bolog-nesi MP, Grant SA. Perioperative dexamethasone administration does not increase the incidence of postoperative infection in to-tal hip and knee arthroplasty: A retrospective analysis. J Arthro-plasty. 2016; 31(8): 1784-1787. doi: 10.1016/j.arth.2016.01.028
Mihara T, Ishii T, Ka K, Goto T. Effects of steroids on quality of recovery and adverse events after general anesthesia: Meta-analysis and trial sequential analysis of randomized clinical tri-als. PLoS One. 2016; 15: 11(9): e0162961. doi: 10.1371/journal. pone.0162961
Sakamoto B, Harker G, Eppstein AC, Gwirtz K. Efficacy of local anesthetic with dexamethasone on the quality of recovery following total extraperitoneal bilateral inguinal hernia repair: A randomized clinical trial. JAMA Surg. 2016; 151(12): 1108- 1114. doi: 10.1001/jamasurg.2016.2905
Pauls RN, Crisp CC, Oakley SH, et al. Effects of dexametha-sone on quality of recovery following vaginal surgery: A ran-domized trial. Am J Obstet Gynecol. 2015; 213: 718.e1-7. doi: 10.1016/j.ajog.2015.05.061
Valentin LS, Pereira VF, Pietrobon RS, Schmidt AP, Oses JP et al. Effects of single low dose of dexamethasone before non-cardiac and nonneurologic surgery and general anesthesia on postoperative cognitive dysfunction—A Phase III double blind, randomized clinical trial. PLoS One. 2016; 6: 11.
Sethi R, Naqash IA, Bajwa SJ, Dutta V, Ramzan AU, Za-hoor SA. Evaluation of hyperglycaemic response to intra-op-erative dexamethasone administration in patients undergoing elective intracranial surgery: A randomised, prospective study. Asian J Neurosurg. 2016; 11(2): 98-102. doi: 10.4103/1793- 5482.177660
Kainulainen S, Törnwall J, Koivusalo AM, Suominen AL, Lassus P. Dexamethasone in head and neck cancer patients with microvascular reconstruction: No benefit, more complica-tions. Oral Oncol. 2017; 65: 45-50. doi: 10.1016/j.oraloncol-ogy.2016.12.008
Low Y, White WD, Habib AS. Postoperative hyperglycemia after 4- vs 8-10-mg dexamethasone for postoperative nausea and vomiting prophylaxis in patients with type II diabetes mellitus: A retrospective database analysis. J Clin Anesth. 2015; 27: 589- 594. doi: 10.1016/j.jclinane.2015.07.003
Wang J, Li J, Cao H, Zhou X, Tang Q. Intravenous lidocaine suppresses dexamethasone-induced perineal pruritus during an-esthesia induction: A randomized controlled, double blind study. Pak J Pharm Sci. 2015; 28(2): 569-572.
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