Top

BMC Anesthesiology

Published in:

Open Access 01-12-2015 | Research article

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

Authors: Szilard Szucs, David Jessop, Gabriella Iohom, George D. Shorten

Published in: BMC Anesthesiology | Issue 1/2015

Abstract

Background

Fractured 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.

Methods

Institutional 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.

Results

Thirty 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].

Conclusions

A 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 registration

ClinicalTrials.gov identifier: NCT01550146, date of registration: 07/03/2012

Haentjens P, Magaziner J, Boonen S. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Int Med. 2010;152(6):380–90.CrossRefPubMedPubMedCentral

Miller AH, Spencer RL, Pulera M, Kang S, McEwen BS, Stein M. Adrenal steroid receptor activation in rat brain and pituitary following dexamethasone: implications for the dexamethasone suppression test. Biol Psychiatry. 1992;32:850–69.CrossRefPubMed

Van Rijen EAM, Harvey RA, Barton RN, Rose JG, Horan MA. Sensitivity of mononuclear leucocytes to glucocorticoids in elderly hip fracture patients resistant to suppression of plasma cortisol by dexamethasone. Eur J Endocrin. 1998;138:659–66.CrossRef

Törnhage CJ. Salivary cortisol for assessment of hypothalamic-pituitary-adrenal axis function. Neuroimmunomodulation. 2009;16(5):284–9.CrossRefPubMed

Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative analgesic effect when dexamethasone is added to nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery. Anesth Analg. 2007;105:481–6.CrossRefPubMed

Kardash KJ, Sarrazin F, Tessler MJ, Velly AM. Single-dose dexamethasone reduces dynamic pain after total hip arthroplasty. Anesth Analg. 2008;106:1253–7.CrossRefPubMed

Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, Akbarian-Tefaghi N. The effect of intravenous administration of dexamethasone on postoperative pain, nausea and vomiting after intrathecal injection of meperidine. Anesth Analg. 2007;104:987–99.CrossRefPubMed

Kakodkar PS. Routine use of dexamethasone for postoperative nausea and vomiting: the case for. Anaesth. 2013;68:889–91.CrossRef

Bartlett R. Routine use of dexamethasone for postoperative nausea and vomiting: the case against. Anaesth. 2013;68:892–6.CrossRef

10.

Turner-Cobb JM, Osborn M, ad Silva L, Keogh E, Jessop DS. Sex differences in hypothalamic-pituitary-adrenal axis function in patients with chronic pain syndrome. Stress. 2010;13:292–300.CrossRefPubMed

11.

Chudinov A, Berkenstadt H, Salai M, Cahana A, Perel A. Continuous psoas compartment block for anaesthesia and postoperative analgesia in patients with hip fractures. RAPM. 1999;24(6):563–8.PubMed

12.

Szucs S, Iohom G, O’Donnell B, Sajgalik P, Ahmad I, Salah N, Shorten G. Analgesic efficacy of continuous femoral nerve block commenced prior to operative fixation of fractured neck of femur. Periop Med (Lond). 2012;1:4.

13.

Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48(11):961–4.CrossRefPubMed

14.

Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain and vocal function. Ann Surg. 2008;248(6):1060–6.CrossRefPubMed

15.

Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain and vocal dysfunction: a randomized clinical controlled trial. Head Neck. 2011;33(6):840–66.CrossRefPubMed

16.

Jokela RM, Ahonen JV, Tallgren MK, Marjakangas PC, Korttila KT. The effective analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesth Analg. 2009;109(2):607–15.CrossRefPubMed

17.

Thangaswamy CR, Rewari V, Trikha A, Dehran M. Chandralekha. Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose-response study. J Anesth. 2010;24(1):24–30.CrossRefPubMed

18.

Lunn TH, Kehlet H. Perioperative glucocorticoids in hip and knee surgery-benefit vs. harm? A review of randomized clinical trials. Acta Anaesth Scand. 2013;57(7):823–34.CrossRefPubMed

19.

De Oliveira Jr GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115(3):575–88.CrossRefPubMed

20.

Grigoras A, Lee P, Sattar F, Shorten G. Perioperative intravenous lidocaine decrease the incidence of persistent pain after breast surgery. Clin J Pain. 2012;28:567–72.CrossRefPubMed

Title: Postoperative analgesic effect, of preoperatively administered dexamethasone, after operative fixation of fractured neck of femur: randomised, double blinded controlled study
Authors: Szilard Szucs
David Jessop
Gabriella Iohom
George D. Shorten
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-016-0247-5

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2015

Validity and reliability of quality of recovery-35 Thai version: a prospective questionnaire-based study

Dexmedetomidine-ketamine versus Dexmedetomidine-midazolam-fentanyl for monitored anesthesia care during chemoport insertion: a Prospective Randomized Study

Erratum to: The effects of arginase inhibitor on lung oxidative stress and inflammation caused by pneumoperitoneum in rats

Abdominal girth and vertebral column length can adjust spinal anesthesia for lower limb surgery, a prospective, observational study

A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy

Early ketamine exposure results in cardiac enlargement and heart dysfunction in Xenopus embryos