Analgesic effects of dexamethasone; its use to reduce post-operative pain scores: A double blinded randomised controlled clinical trial

Abstract

Introduction: Progress in acute pain management over the last 30 years has demonstrated that effective pain relief can be achieved with a range of inexpensive drugs and treatments, yet the vast majority of patients in less developed areas of the world have little or no access to even the most limited of therapies that could alleviate their suffering from acute or chronic pain. Dexamethasone is a synthetic glucocorticosteroid, which has minimal mineralocorticoid activity. It is a potent anti-inflammatory drug with 25-50 times the potency of hydrocortisone and is up to sixteen times as potent as prednisolone. It is utilised frequently in the perioperative setting, including prophylaxis against postoperative nausea and vomiting, reduction of airway and cerebral oedema, and it may be useful in the management of acute and chronic pain. The drug has been used successfully in cardiac surgeries as well as tonsillectomies to reduce post-operative opioid requirements. Few studies have been done on general surgery patients, none in Mulago hospital, with regards to these beneficial effects of dexamethasone. Objective and purpose: the main objective was to compare the 24-hour post-operative pain scores after intraoperative dexamethasone 12mg versus placebo in adult patients undergoing elective laparotomies, mastectomies and thyroidectomies, in Mulago hospital. If there was a statistically significant result then pain management protocols in the hospital would be amended to include the drug. Methodology: the study was a randomized, double blinded, placebo-controlled trial, with patients ASA I and II patients randomized using block randomization equally between the two study arms. Results: We found that patients treated with dexamethasone did not experience less pain or require less rescue analgesia as compared to the patients treated with the placebo. Conclusion: In a population undergoing mastectomies, thyroidectomies and laparotomies, an intravenous dose of 12 mg of dexamethasone was not superior to placebo with regards to pain control as measured at 24 hours after surgery.