Single Dose Of Intravenous Dexamethasone Research Articles

Comparative study of dexamethasone premedication regimens with docetaxel chemotherapy in early HER-2 positive breast cancer: A safety net hospital experience.

Docetaxel can cause fluid retention reactions (FRRs) and hypersensitivity reactions (HSRs). The manufacturer recommends a multi-day oral dexamethasone premedication to prevent these toxicities, but steroid related side effects and regimen compliance remain a concern. This study aimed to determine if modified dexamethasone premedication regimens resulted in differences in HSRs or FRRs to docetaxel. We also examined side effects of dexamethasone and delays in chemotherapy. A retrospective chart review was conducted on 82 early breast cancer patients treated with docetaxel. Three steroid regimens were examined: IV 20 mg single-dose dexamethasone, or IV 12 mg dexamethasone with either dexamethasone 8 mg BID for three days starting the day before chemotherapy or dexamethasone 4 mg BID for three days following chemotherapy. Adverse effects, delays in chemotherapy, and reasons for delays in chemotherapy were recorded. The incidence and severity of FRRs and HSRs was low, with less than 10% incidence of HSRs or FRRs in any group. Delays were most common in the group receiving dexamethasone 8 mg BID for 3 days starting the day before chemotherapy (63.3%) (p < 0.05) and were most commonly due to patient noncompliance (26%). A single dose of intravenous dexamethasone alone or followed by lower doses of oral dexamethasone may improve patient compliance and avoid delays in chemotherapy, without an increase in docetaxel toxicity.

Effect of dexamethasone on antibody response of horses to vaccination with a combined equine influenza virus and equine herpesvirus-1 vaccine.

Dexamethasone is routinely administered to horses but its effect on the antibody response to a commercial EIV/EHV vaccine is unclear. Horses receiving dexamethasone will have lower postvaccination antibody levels against EIV and EHV-1 than vaccinated controls. Fifty-five healthy adult research horses. Randomized cohort study. Control (no vaccine, group 1), vaccination only (EIV/EHV-1/EHV-4, Prestige 2, Merck Animal Health, group 2), vaccination and concurrent single intravenous dose of dexamethasone (approximately .05 mg/kg, group 3), vaccination and 3 intravenous doses of dexamethasone at 24 hours intervals (group 4). Serum SAA levels were measured on day 1 and day 3. Antibody levels against EIV (hemagglutination inhibition assay, Kentucky 2014 antigen) and EHV-1 (multiplex ELISA targeting total IgG and IgG 4/7) were measured on day 1 and day 30. Significantly increased mean antibody titers after vaccination were only noted against EIV and only after the vaccination alone (n = 14, prevaccine mean [prvm] 166.9, SD 259.6, 95% CI 16.95-316.8; postvaccine mean [povm] 249.1, SD 257.2, 95% confidence interval [CI] 100.6-397.6, P = .02) and the single dose dexamethasone (n = 14, prvm 93.14, SD 72.2, CI 51.45-134.8; povm 185.1, SD 118, CI 116.7-253.6, P = .01), but not after multiple doses of dexamethasone (n = 14, prvm 194.3, SD 258.3, CI 45.16-343.4; povm 240.0, SD 235.7, CI 103.9-376.1, P > .05). The effect of dexamethasone on the postvaccine antibody response varies depending on the dosing frequency and the antigen-specific antibody type.

Effect of Single-Dose Preemptive Systemic Dexamethasone on Postoperative Dysphagia and Odynophagia Following Anterior Cervical Spine Surgery: A Double-Blinded, Prospective, Randomized Controlled Trial.

BackgroundThe efficacy of preoperative dexamethasone in anterior cervical discectomy and fusion (ACDF) to reduce dysphagia and odynophagia remains controversial. This study evaluated the effect of a single dose of intravenous dexamethasone given as preemptive analgesia in the ACDF procedure.MethodsA total of 64 patients aged 18 years or over were randomized into two groups. The experimental group received dexamethasone 10 mg intravenously before surgery for 60 minutes, and the control group received normal saline. One surgeon operated on all patients. The Bazaz score and visual analog scale (VAS) for odynophagia were measured at 0 hour, 24 hours, 48 hours, 72 hours, and 2 weeks postoperatively. Prevertebral soft-tissue swelling (PSTS) and the modified Japanese orthopedic association (mJOA) score were measured preoperatively and 2 weeks postoperatively.ResultsThe Bazaz scores at 0, 24, 48, and 72 hours after operation were significantly lower in the dexamethasone group than in the placebo group (p < 0.001, p < 0.001, p < 0.001, and p = 0.004, respectively). The VAS scores of the dexamethasone group were significantly lower than those of the placebo group at 0, 24, 48, and 72 hours after surgery (all p < 0.001), but there was no significant reduction in the Bazaz score and VAS score at 2 weeks postoperatively. There was no difference in PSTS and mJOA preoperatively and 2 weeks postoperatively.ConclusionsA single dose of intravenous dexamethasone used preoperatively in single-level and multilevel ACDF can significantly improve symptoms of dysphagia and odynophagia early on postoperatively.

Pre-operative single dose Dexamethasone in reducing the incidence and severity of post-ercp pancreatitis: A prospective study

Acute pancreatitis is the most common and potentially fatal complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to find out the effectiveness of pre-procedure usage of single dose of intravenous dexamethasone in reducing the incidence and severity of post-ERCP pancreatitis (PEP).

Effect of single-dose intravenous dexamethasone on postoperative pain and postoperative nausea and vomiting in patients undergoing lower segment cesarean section under spinal anesthesia

Background: Lower segment caesarean sections (LSCS) are commonly done under spinal anaesthesia. Although spinal anaesthetic techniques are relatively safe and associated with quick and uneventful recovery, post-operative pain is a major concern after effect of spinal anaesthesia weans off. Other than pain postoperative nausea and vomiting (PONV) is one of the important side effects of spinal anaesthesia. Steroids by virtue of their anti-inflammatory effect is expected to reduce pain consequent upon inflammation and many studies have shown their efficacy in reducing pain as well as PONV in post-operative patients. Aims and Objectives: Primary objective of the study was to evaluate efficacy of single-dose dexamethasone in reducing post-operative pain. The secondary objectives were to analyse effect of single-dose dexamethasone on hemodynamic stability as well as incidence of nausea and vomiting in patients undergoing LSCS under spinal anesthesia. Materials and Methods: This was a double-blind comparative study in which 60 patients undergoing LSCS under spinal anaesthesia were included on the basis of a predefined inclusion and exclusion criteria. Written informed consent was obtained from all patients. The patients were divided into two groups: Group D: 30 patients who received IV dexamethasone 8 mg (2 ml) intravenously just before giving spinal anesthesia. Group N: 30 patients who received Normal saline (2 ml) immediately before spinal anesthesia. In both groups, hemodynamic parameters, respiratory rate, severity of post-operative pain, and incidence of PONV was compared. P value less than 0.05 was taken as statistically significant. Results: Patients in Group D had significantly less severe post-operative pain (as assessed by the Visual analog scale) and incidence of PONV (P&lt;0.05). Significantly less post-operative rescue analgesia was required in patients who received single dose of intravenous dexamethasone (P&lt;0.05). In terms of hemodynamic stability, both groups were found to be comparable with no statistically significant difference. Conclusion: Single-dose dexamethasone is effective in reducing post-operative pain as well as incidence of PONV in patients undergoing LSCS under spinal anesthesia.

Dexamethasone for the treatment of established postoperative nausea and vomiting: A randomised dose finding trial.

Dexamethasone is widely used for the prevention of postoperative nausea and vomiting (PONV) but little is known about its efficacy for the treatment of established PONV. To test the antiemetic efficacy of intravenous dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia and to determine whether there is dose-responsiveness. The DexPonv trial is a multicentre, placebo-controlled, randomised, double-blind, dose-finding study. Inclusion of patients was between September 2012 and November 2017. Follow-up for PONV symptoms was for 24 h. Thirty days postoperatively, patients were contacted by study nurses for any information on postoperative bleeding and infection. Four public hospitals in Switzerland. A total of 803 adults scheduled for elective surgery without any antiemetic prophylaxis signed the consent form; 714 were included. Among those, 319 had PONV and 281 patients were eventually randomised (intention to treat population and safety set). The per protocol set consisted of 260 patients. Patients with PONV symptoms (including retching) were randomised to a single intravenous dose of dexamethasone 3, 6 or 12 mg or matching placebo. The primary endpoint was the absence of further nausea or vomiting (including retching), within 24 h after administration of the study drug. Dexamethasone was ineffective during the first 24 h, whatever the dosage, compared to placebo, even when the model was adjusted for known risk factors (P = 0.170). There were no differences in the time to treatment failure or the quality of sleep during the first night. There was a positive correlation between the dose of dexamethasone and blood glucose concentrations (P < 0.001), but not with bleeding risk, wound infections or other adverse effects. This randomised trial failed to show anti-emetic efficacy of any of the tested intravenous regimens of dexamethasone for the treatment of established PONV in adults undergoing surgery under general anaesthesia. clinicaltrials.gov (NCT01975727).

Single-Dose Intraprocedural Steroid Administration Does Not Impact Early Atrial Fibrillation Recurrence.

To evaluate the effect of single-dose intravenous dexamethasone on atrial fibrillation (AF) recurrence following radiofrequency catheter ablation. A cohort of 84 adult patients (> 18years) underwent catheter ablation at Mayo Clinic Rochester from January to March 2019. Only first-time ablation patients were included, with all re-do ablations excluded to minimize heterogeneity. Administration of intraoperative dexamethasone 4mg or 8mg was determined by chart review from the procedure. At our institution, intraoperative intravenous steroids are administered for postoperative nausea and vomiting (PONV) prophylaxis at the discretion of the anesthesiologist. AF recurrence was determined by ECG or cardiac monitoring within 3months or between 3 and 12months post-ablation with an in-person follow-up visit. A total of 31 (36.9%) patients received intravenous dexamethasone compared to 54 (63.1%) who did not (approximating a 2:1 comparison group). The incidence of documented AF or atrial flutter, lasting greater than 30s, within the first 3months post-ablation was 29.0% in the dexamethasone group versus 24.5% in the non-dexamethasone group (p value 0.80). AF or atrial flutter recurrence at 3-12months post-ablation was 3.2% in the dexamethasone group compared to 9.4% in the non-dexamethasone group (p value 0.41). These data suggest that intraoperative intravenous dexamethasone administered during AF ablation for postoperative nausea and vomiting prophylaxis may not have a significant effect on AF recurrence rates.

Comparative study of oral and IV dexamethasone premedication in the prevention of docetaxel induced allergic reactions.

The hypersensitivity reactions after docetaxel administration is a main concern in this study. The aim of this study is to check the incidence of hypersensitivity reactions (HSRs) after receiving a single dose of intravenous dexamethasone before docetaxel administration. In this retrospective study, 1 year data from Jan 1st 2018 to Dec 31st 2018 was retrieved from hospital information system (HIS). We examined 210 patients who visited hospital during the last 12 months during their cancer treatment and took dexamethasone orally 3 days prior to docetaxel administration or 20 mg intravenously before 15 minutes of docetaxel. Out of 210 patients, only 50 patients were taking IV dexamethasone injection prior to docetaxel constitutes only 23.5% while patients who were taking oral dexamethasone were found to be 160 which constitutes 75%. There was no hypersensitivity reaction with oral and IV dexamethasone before docetaxel administration. Majority of the patients were without taking oral dexamethasone before docetaxel administration which not only saved time but also improve patient compliance. No hypersensitivity reaction had been found either in oral or intravenous dexamethasone prior to docetaxel administration by using patient data from Hospital Information System (HIS). However, intravenous dexamethasone not only improve patient compliance but also reduce the risk of hypersensitivity reactions but the cost of intravenous dexamethasone is higher than the cost of oral dexamethasone. In conclusion, single dose of intravenous IV dexamethasone is preferred treatment option.

Comparative Study of the Prophylactic Effect of Intravenous or Gargling Dexamethasone in Reducing Postextubation Sore Throat and Cough

Background: Sore throat, cough and hoarseness after tracheal extubation are common complications after surgery. Due to the proven effect of dexamethasone on reducing these complications, in this study, we compared the prophylactic effect of intravenous dexamethasone and dexamethasone gargle on sore throat and cough after extubation.&#x0D; Methods: In this clinical trial study, 96 patients between the ages of 18-64 years who underwent elective surgery and intubation under general anesthesia were randomly divided into three groups, respectively, the first group received 6 mg dexamethasone gargle. The second group received 6 mg intravenous dexamethasone and the third group received normal saline. The frequency of cough and sore throat were assessed and compared in these three groups.&#x0D; Results: There was no significant difference between the three groups based on hemodynamic variables and demographic data (P&gt; 0.05). The frequency of cough in the first (1.54± 2.82) and second (1.57±2.73) groups was less than the third group (1.79±3.14), but this difference was not statistically significant (P&gt;0.66). The mean severity of sore throat in the second group and then in the first group was lower at the time of entry into recovery and 2 hours after surgery, than the third group. (P &lt;0.005) Also, the mean severity of sore throat in the second group and then the first group in 24 hours after surgery was significantly lower than the third group. (P &lt;0.005).&#x0D; Conclusion: Prophylactic single-dose intravenous dexamethasone is more effective than dexamethasone gargle in reducing sore throat due to endotracheal intubation. Also, gargling and intravenous injection of dexamethasone, both are effective in reducing postoperative cough without any side effects after extubation.

Single dose of dexamethasone is not associated with postoperative recurrence and mortality in breast cancer patients: a propensity-matched cohort study

BackgroundDexamethasone is widely used in cancer patients despite the concern that perioperative glucocorticoids may potentially cause immunosuppression. However, studies on the influence of dexamethasone on cancer recurrence after curative surgery have produced conflicting results. The goal of our study was to compare postoperative recurrence-free survival and overall survival between patients with breast cancer who received perioperative dexamethasone and those who did not.MethodsThe medical records of 2729 patients who underwent breast cancer surgery between November 2005 and December 2010 were reviewed. These patients were followed up until December 2015. The patients were categorised according whether they received a single dose of intravenous dexamethasone perioperatively or not. Cox regression analyses were conducted to evaluate any associations between dexamethasone usage with postoperative recurrence and mortality. Additionally, we performed a sensitivity test with propensity score matching to adjust for selection bias.ResultsAmong the 2628 patients, 236 (8.5%) received perioperative dexamethasone. No increasing risk for recurrence (hazard ratio [HR], 1.442; 95% confidence interval [CI], 0.969–2.145; P = 0.071) or mortality (HR, 1.256; 95% CI, 0.770–2.047; P = 0.361) after breast cancer surgery were identified in patients who received dexamethasone. Similarly, propensity score matching did not show significant associations in postoperative recurrence (HR, 1.389; 95% CI, 0.904–2.132; P = 0.133) or mortality (HR, 1.506; 95% CI, 0.886–2.561; P = 0.130) in patients who received dexamethasone.ConclusionsWe found that a perioperative single dose of dexamethasone is not associated with increased recurrence or mortality after curative surgery in breast cancer patients.

Clinical effectiveness of single dose of intravenous dexamethasone on the duration of ropivacaine axillary brachial plexus block: the randomized placebo-controlled ADEXA trial.

The effect of intravenous dexamethasone on the duration of axillary plexus block performed using ropivacaine is not described. The aim of this study is to assess the effect of intravenous dexamethasone on the duration of axillary plexus block analgesia after distal upper arm surgery. In this prospective, randomized, placebo-controlled, double-blinded trial, consenting patients scheduled for hand or forearm surgery under ultrasound-guided axillary plexus block performed using 0.5 mL/kg of 0.475% ropivacaine, were randomized to receive an intravenous injection of either 8 mg/2 mL of dexamethasone (Dexa group) or 2 mL of saline (Control). The primary outcome was the time of first analgesic intake after axillary block. Secondary outcomes included motor or sensory block duration, total use of postoperative analgesics, and block-related complications. Among the 98 patients included, 6 and 2 patients did not require postoperative analgesic intake in Dexa and Control groups, respectively (p=0.06). The time of first analgesic intake was significantly longer in the Dexa (20.9±9.3 hours) than in the Control group (14.7±6.6 hours, p<0.0004). Motor and sensory recovery occurred significantly later, and total analgesic consumption was lower in the Dexa than in the Control group. No nerve complication related to intravenous dexamethasone injection was recorded. This study showed that intravenous dexamethasone delayed for 6 hours the time to first analgesic intake after upper arm surgery under axillary plexus block performed with the long-lasting local anesthetic ropivacaine. This suggests that intravenous dexamethasone could be an interesting adjuvant to axillary plexus block. NCT02862327.

The rationale, design, and methods of a randomized, controlled trial to evaluate the efficacy of single-dose dexamethasone in reducing post-embolization syndrome in patients undergoing uterine artery embolization.

BackgroundUterine artery embolization (UAE) is a minimally invasive technique well established for treating symptomatic uterine fibroids. However, the post-procedure recovery for UAE involves a notable inflammatory process in response to ischemia known as post-embolization syndrome (PES). PES encompasses transient leukocytosis, low-grade fever, and can result in readmission of up to 10% of patients. In surgical settings, multiple studies have demonstrated the efficacy of glucocorticoids in reducing inflammation and associated pain. However, this approach has not yet been assessed in predominantly ischemia-driven PES.MethodsThis paper describes the protocol of a prospective randomized, double-blind, placebo-controlled, multi-center trial to test the efficacy and safety of single-dose dexamethasone on inflammatory responses, pain, nausea, and readmission rates after UAE. The study will enroll pre-menopausal patients between 25 and 55 years (planned enrollment, n = 60) with MRI confirmed symptomatic fibroids. Patients will be randomly allocated into two groups: single-dose intravenous dexamethasone plus standard of care or placebo (normal saline) plus standard of care.ResultsThe primary endpoint is the patient pain score 4 h following the UAE procedure. Secondary endpoints include pain scores at 7 h and 24 h following UAE; narcotic usage in the first 24 h following UAE; and serum inflammatory markers (white blood cell count, C-reactive protein [CRP], interleukin-6 [IL-6], and cortisol) 24 h after UAE.ConclusionGiven the high incidence of post-procedure pain and difficulty with pain control after uterine artery embolization, results of this trial may directly influence the standard of care in perioperative management of patients undergoing UAE.

Effect of single-dose intravenous dexamethasone on subjective voice quality after thyroidectomy: A meta-analysis.

Background:Corticosteroids are widely used to treat voice change after thyroidectomy. In this study, we evaluated the effect of a single dose of intravenous dexamethasone after thyroidectomy using a metaanalysis.Methods:Relevant studies were identified by searching the following databases: Medline, Embase, and Cochrane through February 2017. We followed PRISMA guidelines. The following search terms were used: “thyroidectomy,” “voice,” “steroid.” Random-effects models were used to estimate standardized mean differences (SMDs) and 95% confidence intervals.Results:Our search yielded one retrospective cohort study involving 122 thyroidectomy patients and 3 randomized controlled studies involving 242 thyroidectomy patients. The pooled SMD for voice quality after thyroidectomy was −0.80 (P < .05). Subgroup analysis showed significant voice quality change 1 day after administration of dexamethasone.Conclusions:Single-dose intravenous dexamethasone after thyroidectomy significantly improves subjective voice quality on day 1. The effect was not different significantly after day 1.Level of evidence:Level 2a.

The effects of a combination of intravenous dexamethasone and ketamine on postoperative mood in patients undergoing laparoscopically assisted-gynecologic surgery.

It has been known that anesthetic adjuvants such as dexamethasone or ketamine might change mood. This study aimed to investigate the effects of a single dose of each drug individually along with their combined usage on postoperative mood changes in patients undergoing gynecologic surgery. Two hundred ninety-seven patients randomly allocated were divided into three groups. Group K (n = 99) received a single dose of ketamine (0.5mg/kg iv); group D (n = 99) received a single dose of dexamethasone (0.1mg/kg iv), and group KD (n = 99) received both ketamine (0.5mg/kg iv) and dexamethasone (0.1mg/kg iv) at 5min after the induction of anesthesia. A change in the patient health questionnaire (PHQ)-9 scores on the first and third day after surgery, the duration of anesthesia, the postoperative visual analog scale (VAS) for pain, and the patient controlled analgesia (PCA) consumption were evaluated. Groups K and KD showed a significant reduction in PHQ-9 score on both the first and third day after surgery compared with those recorded preoperatively and in group D (P < 0.01). There were no differences in the group D PHQ-9 scores pre- and post-operatively. The VAS for pain 24h after surgery and the PCA consumption in group KD decreased significantly compared to the other two groups (P < 0.05). A single dose of ketamine (0.5mg/kg) with or without combination with dexamethasone (0.1mg/kg) give iv 5min after induction of general anesthetic produced significant improvement in the postoperative mood scores. A single intravenous dose of dexamethasone (0.1mg/kg) alone did not change postoperative mood scores. The VAS for pain 24h after surgery and the PCA consumption was significantly lower in patients who received combination of both drugs.

The effect of a single intraoperative dose of intravenous dexamethasone 8 mg on post-cesarean delivery analgesia: a randomized controlled trial

BackgroundA single perioperative dose of dexamethasone has been shown to improve postoperative analgesia and reduce opioid consumption. However, this analgesic and opioid sparing effect has not been well assessed as part of a multimodal analgesic regimen in women post-cesarean delivery. MethodsHealthy women having cesarean delivery under spinal anesthesia were randomly assigned to receive intravenous dexamethasone 8 mg or placebo after delivery and clamping of the umbilical cord. The primary outcome variable was total opioid consumption in the 24 hours following cesarean delivery. We hypothesized that a single dose of intravenous dexamethasone, administered as part of a multimodal analgesia regimen after spinal anesthesia for cesarean delivery, would significantly reduce postoperative opioid consumption. ResultsFifty-two women were enrolled and randomized to two groups of 26 patients. The median (IQR) opioid consumption in the first 24 hours after cesarean delivery was 12 mg (5–20 mg) in the dexamethasone group compared to 15 mg (5–22 mg) in the placebo group. The median difference in opioid consumption at 24 hours (95% CI) was −3 mg (−12.2 to 5.7) and was not significantly different between groups (P=0.32). ConclusionsThe addition of intravenous dexamethasone 8 mg to a multimodal postoperative analgesic regimen that included intrathecal morphine, in women who had a cesarean delivery under spinal anesthesia, did not reduce 24 hour postoperative opioid consumption.

The Effect of Single-dose Intravenous Dexamethasone on Postoperative Pain and Postoperative Nausea and Vomiting in Patients Undergoing Surgery under Spinal Anesthesia: A Double-blind Randomized Clinical Study.

Background:The use of neuraxial anesthesia has dramatically increased. Acute postoperative pain is an undesirable outcome that can delay functional recovery for patients undergoing surgery. Nausea and vomiting in the postoperative period occurs in 20%–30% of the patients and together are the second-most common complaint reported (pain is the most common). Efficacy of glucocorticoids for reducing pain and inflammation after surgery is being explored. Glucocorticoids are strong anti-inflammatory agents, which can be used for a short-time postoperative pain control in various surgeries. Dexamethasone is a glucocorticoid with little mineralocorticoid effect commonly used perioperatively to reduce postoperative nausea and vomiting (PONV) and has a beneficial role in postoperative analgesia. Dexamethasone has also an antiemetic effect, in addition to its anti-inflammatory and analgesic effects.Aim:The main purpose of this study is to evaluate the effect of administration of single-dose intravenous (i.v.) dexamethasone on postoperative pain and PONV in patients undergoing surgery under spinal anesthesia.Settings and Design:A double-blind randomized clinical study was performed in our institute between November 2014 and October 2015 after obtaining clearance from the ethical committee.Materials and Methods:A double-blind randomized clinical study was performed on 60 patients posted for surgery under spinal anesthesia. Patients were randomly assigned into two groups: A (study: 2 ml [8 mg] dexamethasone) and B (control: 2 ml saline). In both the groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate, severity of pain (based on visual analog scale), and other symptoms such as nausea and vomiting were recorded at different time points during the first 24 h after surgery. Statistical methods using Student t-test (two-tailed, independent) and Fischer's exact test were used for analyzing the data.Results:Between-group comparisons indicated significant differences in terms of severity of postoperative pain and PONV (P < 0.001), MAP (P = 0.063), and HR (P = 0.071), which in the study group were lower than the control group.Conclusion:i.v. dexamethasone is efficient in reducing postoperative pain, requirement of rescue analgesia on the first postoperative day, and incidence of PONV with no significant changes in vital signs.

The Effect of Postoperative Single-Dose Intravenous Dexamethasone on Common Complications After Tonsillectomy in Children: A Randomized Controlled Trial

Background: Tonsillectomy is associated with early and late postoperative complications in the children. Previous studies have shown some effects of dexamethasone; however, there has been a lack of studies that evaluate its effects on other complications, including odynophagia and otalgia. Objectives: We aimed to investigate the effects of dexamethasone on odynophagia and otalgia after surgery. Patients and Methods: In this randomized clinical trial, 100 patients who underwent adenotonsillectomy were divided into two groups: one group received 0.1 mg/kg of dexamethasone (case) and the other received Ringer serum as a placebo (control). Intravenous (IV) dexamethasone was prescribed to be administered by a nurse on the ward. The incidence of bleeding, nausea and vomiting, odynophagia, voice change, acetaminophen intake, halitosis and otalgia, and activity were evaluated at 24 h and during the first 7 days after surgery. Results: The mean ages of patients were 7.1 ± 2.8 and 6.5 ± 2.4 years in the control and case groups, respectively. The overall proportions of females and males were 41% and 59%, respectively. No significant difference in demographic data was seen between the two groups (P > 0.05). There was a significant difference in terms of odynophagia and nausea and vomiting between the case and control groups after 24 h (P = 0.001). There was no significant difference between the case and control groups in terms of bleeding, voice change, halitosis, or nausea and vomiting after 7 days (P > 0.05). Meanwhile, there were a significant difference in the incidence of acetaminophen intake (60% vs. 30%, P = 0.002), odynophagia (24% vs. 6%, P = 0.011), otalgia (20% vs. 4%, P = 0.014), and activity (80% vs. 98%, P = 0.004) of patients after 7 days between the groups. Conclusions: In children undergoing adenotonsillectomy, dexamethasone has a significant antiemetic effect and decreases odynophagia, otalgia, and the need for analgesia.

Does Dexamethasone Improves Postoperative Day Care Surgery Outcome When Used As Additive To Local Infiltration Anesthesia: A Randomized case control study

Introduction: Up till now almost all studies used either single intravenous dose of dexamethasone in perioperative period for post operative pain relief or perineurally in regional anesthesia along with local anesthetic agent to prolong the regional anesthesia. The recent animal studies shown the neurotoxicity of perineurally used injection dexamethasone. This study was planned to evaluate the effect of single dose of dexamethasone in infiltration with local anesthetic agent in day care surgical procedure. Methodology: Cases selection is from ASA – grade I & II patients posted for day care surgical procedure be done under local infiltration anesthesia. The patients are randomly allocated into two groups. Dexamethasone group-GD —25 patients. Control group- GC -26 patients patients were observed for symptoms of perineal itching, effect at the site of local infiltration and PONV. Post operative pain was evaluated half hourly after end of surgical procedure. Pain score is noted by numeric rating scale (NRS) at first pain, after one hour of analgesic and at the time of discharge from the hospital. They were followed up to 7 to 8 days for wound healing and stitch removal. Observation: The average time of first pain was 259.1 min and 120 min in Group D & C respectively. NRS pain score after rescue analgesic in group D was significantly lower than Group C. Amongst Group D four patients did not required any analgesic till the time of discharge on the same day. From Group C four patients needed additional analgesic Itching at the site of local infiltration perineal itching and PONV was not significant. Conclusion-We conclude that addition of injection dexamethasone with injection lignocaine for local infiltration anesthesia delays the requirement of first analgesic significantly. In addition to this the analgesic effect of injection dexamethasone along with injection diclofinac is highly promising. Keywords: Analgesia, Day care, Dexamethasone, Infiltration anesthesia, Po

The effects of single-dose dexamethasone on inflammatory response and pain after uterine artery embolisation for symptomatic fibroids or adenomyosis: a randomised controlled study.

To investigate the effects of single-dose intravenous dexamethasone on inflammatory responses, pain, nausea, and vomiting after uterine artery embolisation (UAE). Prospective, randomised, double-blind, and placebo-controlled study. Tertiary-care University centre in Korea. Patients undergoing UAE for the treatment of symptomatic fibroids or adenomyosis. Patients were randomised to receive either intravenous dexamethasone (10 mg; dexamethasone group) or normal saline (control group) 1 hour before UAE. Both groups received fentanyl-based intravenous patient-controlled analgesia (PCA) during the 24 hours after UAE. The primary outcomes were the inflammatory and stress responses measured by white blood cell count, neutrophil percentage, C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol. Secondary outcomes were severity of pain and incidence of nausea and vomiting. Sixty-four patients were enrolled and 59 patients completed the study. CRP, IL-6, and cortisol were significantly lower in the dexamethasone group compared with the control group during the 24 hours after UAE. Although the cumulative dose of fentanyl and additional analgesics administered during the 24 hours after UAE were similar between the two groups, pain scores were significantly lower in the dexamethasone group from 12 hours after UAE, and the incidence of severe nausea and vomiting was lower in the dexamethasone group. The administration of single-dose intravenous dexamethasone as an adjunct to fentanyl-based intravenous PCA is effective in reducing inflammation and pain during the first 24 hours after UAE. Dexamethasone is effective in reducing inflammation and pain after uterine artery embolisation.

Postoperative analgesic effect, of preoperatively administered dexamethasone, after operative fixation of fractured neck of femur: randomised, double blinded controlled study.

BackgroundFractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur.MethodsInstitutional ethical approval was granted and written informed consent was obtained from each patient. Patients awaiting for surgery at Cork University Hospital were recruited between July 2009 and August 2012. Participating patients, scheduled for surgery were randomly allocated to one of two groups (Dexamethasone or Placebo). Patients in the dexamethasone group received a single dose of intravenous dexamethasone 0.1 mg kg -1 immediately preoperatively. Patients in the placebo group received the same volume of normal saline. Patients underwent operative fixation of fractured neck of femur using standardised spinal anaesthesia and surgical techniques. The primary outcome was pain scores at rest 6 h after the surgery.ResultsThirty seven patients were recruited and data from thirty patients were analysed. The groups were similar in terms of patient characteristics. Pain scores at rest 6 h after the surgery (the principal outcome) were lesser in the dexamethasone group compared with the placebo group [0.8(1.3) vs. 3.9(2.9), mean(SD) p = 0.0004]. Cumulative morphine consumption 24 h after the surgery was also lesser in the dexamethasone group [7.7(8.3) vs. 15.1(9.4), mean(SD) mg, p = 0.04].ConclusionsA single dose of intravenous dexamethasone 0.1 mg kg -1 administered before operative fixation of fractured neck of femur improve significantly the early postoperative analgesia.Trial registrationClinicalTrials.gov identifier: NCT01550146, date of registration: 07/03/2012