Batistaki Chrysanthi, Kaminiotis Evagelia, Papadimos Thomas, Kostopanagiotou Georgia
*2nd Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece †Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, OH.
Clin J Pain. 2017 Nov;33(11):1037-1046. doi: 10.1097/AJP.0000000000000486.
The effect of dexamethasone on analgesic consumption has not been adequately studied. The aim of this review was to investigate recent literature regarding the possible effect of dexamethasone on postoperative analgesic consumption.
Critical review of randomized trials and prospective consecutive studies investigating the postoperative analgesic effect of dexamethasone was performed. Only studies published during 2006 to 2015 were included.
Forty-one studies met the inclusion criteria; 33 in adults and 8 in children (9 in general surgery, 8 in gynecologic/breast surgery, 8 in orthopedic/spinal surgery, 8 in head/neck surgery, 7 in children's tonsillectomy, and 1 in children's orchiopexy). Literature review demonstrated that dexamethasone can decrease analgesic requirements in patients undergoing laparoscopic cholecystectomies, laparoscopic gynecologic and breast surgery; whereas there is no consensus regarding orthopedic procedures, with positive evidence mostly regarding spinal surgeries. The efficacy of dexamethasone during head and neck surgery is not conclusive; however, its use before thyroid surgery may be beneficial. In children a beneficial impact of dexamethasone administration was revealed on posttonsillectomy reduction of analgesic needs. Studies on other kinds of operations in children are lacking.
Dexamethasone administered at a dose of 8 mg before surgical incision may be beneficial in laparoscopic cholecystectomies, thyroid, laparoscopic gynecologic and breast surgery, and tonsillectomies in children. Dexamethasone's potential impact on reducing postoperative analgesic requirements should be investigated in more detail in a systematic manner, to support its use in other kinds of operations.
地塞米松对镇痛药物用量的影响尚未得到充分研究。本综述的目的是调查近期有关地塞米松对术后镇痛药物用量可能产生影响的文献。
对研究地塞米松术后镇痛效果的随机试验和前瞻性连续研究进行批判性综述。仅纳入2006年至2015年期间发表的研究。
41项研究符合纳入标准；其中33项针对成人，8项针对儿童（9项为普通外科手术，8项为妇科/乳腺手术，8项为骨科/脊柱手术，8项为头颈外科手术，7项为儿童扁桃体切除术，1项为儿童睾丸固定术）。文献综述表明，地塞米松可降低接受腹腔镜胆囊切除术、腹腔镜妇科和乳腺手术患者的镇痛需求；而对于骨科手术尚无定论，大多是脊柱手术有阳性证据。地塞米松在头颈外科手术中的疗效尚无定论；然而，在甲状腺手术前使用可能有益。在儿童中，地塞米松给药对扁桃体切除术后镇痛需求的减少有有益影响。缺乏关于儿童其他类型手术的研究。
手术切口前给予8毫克剂量的地塞米松可能对腹腔镜胆囊切除术、甲状腺手术、腹腔镜妇科和乳腺手术以及儿童扁桃体切除术有益。应更系统地详细研究地塞米松在降低术后镇痛需求方面的潜在影响，以支持其在其他类型手术中的应用。
