This preprint is under consideration at Perioperative Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
Research
Ciara Mitchell
UCL: University College London
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2981-2099
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery.
Objective
To determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia.
Methods
This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge.
Results
Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤4 hours were reduced in patients who received dexamethasone at rest (mean difference (MD), -0.54, 95% confidence interval (CI) -0.72 to -0.35, I2 = 81%) and on movement (MD -0.42, 95% CI -0.62 to -0.22, I2 = 35 ). In the dexamethasone group 4–24 hour pain scores were less at rest (MD -0.31, 95% CI -0.47 to -0.14, I2 = 96) and on movement (MD -0.26, 95% CI -0.39 to -0.13, I2 = 29) and pain scores ≥24 hours were reduced at rest (MD -0.38, 95% CI -0.52 to -0.24, I2 = 88) and on movement (MD -0.38, 95% CI -0.65 to -0.11, I2 = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I2 = 98), opioid requirements (mg oral morphine) decreased (MD -6.66, 95% CI -9.38 to -3.93, I2 = 88) and no difference in time to PACU discharge (MD -3.82, 95% CI -10.87 to 3.23, I2 = 59%).
Conclusions
Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery.
Keywords
dexamethasone, postoperative pain, abdominal surgery
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 27 May, 2021
No community comments so far
Reviewer #2 agreed
On 26 Oct, 2021
Review #2 received
Received 26 Oct, 2021
Review #1 received
Received 06 Jun, 2021
Reviewer #1 agreed
On 01 Jun, 2021
Reviewers invited
Invitations sent on 31 May, 2021
Editor assigned
On 30 May, 2021
Editor invited
On 30 May, 2021
Submission checks complete
On 25 May, 2021
First submitted
On 20 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This preprint is under consideration at Perioperative Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Ciara Mitchell
UCL: University College London
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2981-2099
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 27 May, 2021
No community comments so far
Reviewer #2 agreed
On 26 Oct, 2021
Review #2 received
Received 26 Oct, 2021
Review #1 received
Received 06 Jun, 2021
Reviewer #1 agreed
On 01 Jun, 2021
Reviewers invited
Invitations sent on 31 May, 2021
Editor assigned
On 30 May, 2021
Editor invited
On 30 May, 2021
Submission checks complete
On 25 May, 2021
First submitted
On 20 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Previous meta-analysis of heterogeneous surgical cohorts demonstrated reduction in postoperative pain with perioperative intravenous dexamethasone, but none have addressed adults undergoing elective abdominal surgery.
Objective
To determine the impact of intravenous perioperative dexamethasone on postoperative pain in adults undergoing elective abdominal surgery under general anaesthesia.
Methods
This review was prospectively registered on the international prospective register of systematic reviews (CRD42020176202). Electronic databases Medical Analysis and Retrieval System Online (MEDLINE), Exerpta Medica Database (EMBASE), (CINAHL) Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and trial registries were searched to January 28 2021 for randomised controlled trials, comparing dexamethasone to placebo or alternative antiemetic, that reported pain. The primary outcome was pain score, and secondary outcomes were time to first analgesia, opioid requirements and time to post-anaesthesia care unit (PACU) discharge.
Results
Fifty-two studies (5768 participants) were included in the meta-analysis. Pain scores ≤4 hours were reduced in patients who received dexamethasone at rest (mean difference (MD), -0.54, 95% confidence interval (CI) -0.72 to -0.35, I2 = 81%) and on movement (MD -0.42, 95% CI -0.62 to -0.22, I2 = 35 ). In the dexamethasone group 4–24 hour pain scores were less at rest (MD -0.31, 95% CI -0.47 to -0.14, I2 = 96) and on movement (MD -0.26, 95% CI -0.39 to -0.13, I2 = 29) and pain scores ≥24 hours were reduced at rest (MD -0.38, 95% CI -0.52 to -0.24, I2 = 88) and on movement (MD -0.38, 95% CI -0.65 to -0.11, I2 = 71). Time to first analgesia (minutes) was increased (MD 22.92, 95% CI 11.09 to 34.75, I2 = 98), opioid requirements (mg oral morphine) decreased (MD -6.66, 95% CI -9.38 to -3.93, I2 = 88) and no difference in time to PACU discharge (MD -3.82, 95% CI -10.87 to 3.23, I2 = 59%).
Conclusions
Patients receiving dexamethasone had reduced pain scores, postoperative opioid requirements and longer time to first analgesia. Dexamethasone is an effective analgesic adjunct for patients undergoing abdominal surgery.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Loading...