Dexamethasone as analgesic in different types of gynecologic surgery – A literature review

Abstract

Background: Dexamethasone is a glucocorticoid and is widely used for postoperative nausea and vomiting (PONV). Recent studies and subsequent guidelines also suggest a role as an analgesic. Dexamethasone as an analgesic has been studied with varying degrees of success in different types of surgery with intravenous doses ranging from 4 mg to 80 mg. The procedure specific postoperative pain management (PROSPECT) guidelines for elective cesarean sections, laparoscopic hysterectomy and oncologic breast surgery all recommend the use of dexamethasone as an analgesic in a multimodal pain regimen, however a particular dose is not mentioned. Objective: To provide a literature review of the use of dexamethasone as an analgesic and at what dosage it has been studied in elective cesarean sections, gynecological laparoscopy and oncologic breast surgery. Methods: The Embase, PubMed, and Cochrane databases were searched for randomized controlled trials published between 2000 and 2021. Results: A total of thirty-four articles were found. Fourteen about elective cesarean section, Thirteen concerning gynecologic laparoscopy and seven regarding oncologic breast surgery. Literature review demonstrated that during elective cesarean section the intravenous (IV) doses ranged from 4 mg to 16 mg. The most investigated IV dose was 8 mg, but overall studies showed conflicting results concerning pain scores and analgesic use. In gynecologic laparoscopy the IV dose ranged from 4 mg to 15mg and again 8 mg was the most frequently studied dose. The IV dose of dexamethasone in oncologic breast surgery ranged from 8 mg to 24 mg. Also in these studies the results were conflicting. In addition, dexamethasone was used as an adjunct to locoregional blocks (perineural use): the transversus abdominis block (TAP) in cesarean section, the serratus anterior plane block (SAP) and the paravertebral block (PVB) in oncologic breast surgery. Conclusion: This literature review provides an overview of the use of dexamethasone in elective cesarean section, gynecologic laparoscopic surgery and oncological breast surgery. Three routes of administration were examined: intravenous, perineural and intraperitoneal. IV 8 mg dexamethasone was the most studied dosage but there were mixed results. Based on this literature review we cannot draw any conclusions regarding the analgesic dose. Further research, with more qualitative RCT’s and systematic reviews with meta-analysis are needed.