Multimodal pain management with glucocorticoids: killing two birds with one stone or shooting sparrows with cannons?

Abstract

he main objectives for goal-directed postopera-tive pain management are optimal postopera-tive pain relief; reduction of adverse events such asnausea, vomiting, and sedation; and a shorter dura-tion of convalescence without compromising safety.To achieve these goals, it is most often necessary tocombine analgesics that target different sites or havedifferent mechanisms, resulting in additive or syn-ergisticeffects.Thismultimodalapproachinvolvesabalanced cocktail of different drugs such as opioids,paracetamol, nonsteroidal anti-inflammatory drugs(NSAIDs), local anaesthetics, and glucocorticoids.The aim of this approach is to reduce some of theadverse events postoperatively; however, the addi-tion of each new drug also increases the risk fordrug-related side effects and complications. Thus,the key question is: Does the benefit of adding asupplementary co-analgesic to a multimodal regimeoutweigh the harm?In the current issue of Acta AnaesthesiologicaScandinavica, Lunn and Kehlet investigated thisquestioninthepaper:‘Perioperativeglucocorticoidsin hip and knee surgery – benefit vs. harm? Areview of randomised clinical trials’.