The Effect of Dexamethasone on the Dynamics of Inflammation, Cortisol and analgesia in Lower Limb Surgery

Abstract

Background: Dexamethasone is currently used as a part of multimodal analgesia on postoperative pain management. Dexamethasone considered providing effective analgesia as a steroid anti-inflammatory. This study aimed to examine the effects of preoperative single dose of intravenous dexamethasone to the inflammation, cortisol response and analgesia in lower limb surgery. Methods: This is a clinical experimental study conducted in randomized double-blind trial performed at Wahidin Sudirohusodo Hospital, Makassar Indonesia. Thirty patients with lower limb surgery under spinal anesthesia meet the inclusion criteria were randomly divided into 2 groups: (1) group received 8 mg dexamethasone intravenous preoperatively and perioperative analgesia with paracetamol and PCA morphine (dexamethasone group) and (2) group received perioperative analgesia paracetamol and PCA morphine (control group). Blood samples were taken at the time before anesthesia, immediately post-surgery, 4 and 24 hours after surgery to measure plasma levels of CRP and Cortisol with the ELISA test. We recorded the intensity of rest pain and morphine requirement in 4 and 24 hours after surgery. Results: Both of groups found increase in CRP plasma levels at the 24 hours after surgery (p<0.05). Cortisol in the dexamethasone group decreased significantly at the 24 hours after surgery while in the control group did not change (p<0.05). Rest pain intensity and morphine requirement in the dexamethasone group was lower in the 24 hours after surgery than the control group (p<0.05). No differences changes in blood pressure, heart rate, respiration and the side effects between the two groups. Conclusion: The addition of single dose dexamethasone preoperatively on the combination of paracetamol and morphine did not abolish inflammation process but decrease cortisol response after surgery with sufficient analgesia and minimal side effect.