Intravenous Dexamethasone Reduces Pain in Middle Ear Surgery

Document Type : Original

Authors

1 Department of Anesthesiologie, Habib Bourguiba University Hospital, 3000 Sfax /Tunisia. Faculty of Medicine of Sfax; University of Sfax.

2 Department of Otorhinolarygologie, Habib Bourguiba University Hospital, 3000 Sfax/Tunisia

Abstract

Introduction:
Few studies evaluated the treatment of postoperative pain in middle ear surgery.
Materials and Methods:
We conducted a randomized clinical trial to evaluate the efficacy of dexamethasone in the management of postoperative pain in middle ear surgery. Group G1 received an intravenous injection of 2 ml of physiological saline 30 minutes before the end of the procedure. Group G2 received a 2 ml intravenous solution containing 8 mg of dexamethasone, 30 minutes before the end of the procedure. Pain perception was measured by the Visual an alogscale (VAS) every 10min during the first hour and the nevery 6 hours during the 24 hours postoperatively. The delay of the first analgesic demand and the consumption of analgesics use during the first 24 hours postoperatively, were recorded.
Results:
VAS values were lower in G2at all measurement points during the first hour, as well as the first 24h postoperatively (Mann-Whitney test, P<0.05).The delay of the analgesic request was (0 (0-60) for G1 versus 0 (0-80) for G2, P=0.04, Mann-Whitney test). Morphine was used in 44% of the patients in G1 against 19% for G2 (P = 0.031). There was a significant difference between G1 and G2 in terms of the total dose of morphine consumed (P= 0.028, Mann-Whitney test). Paracetamol demand was lower in group 2 at all points of assessment during the first 24 hours postoperatively.
Conclusions:
Intravenous dexamethasone is effective in decreasing pain and analgesic requirement, during the first 24 hours postoperatively, in patients undergoing middle ear surgery.

Keywords

References

  1. Wittekindt D, Wittekindt C, Meissner W, Guntinas-Lichius O. [Postoperative pain assessment after middle ear surgery].HNO.nov 2012; 60(11): 974‑
  2. Afman CE, Welge JA, Steward DL. Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg. févr 2006;134(2):181‑
  3. Fujii Y, Nakayama M. Dexamethasone for the reduction of postoperative nausea and vomiting and analgesic requirements after middle ear surgery in adult Japanese patients. Methods Find Exp Clin Pharmacol. juin 2009;31(5):337‑
  4. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. sept 2011;115(3):575‑
  5. Effect of high-dose intravenous dexamethasone

 

on postlumbar discectomy pain. - PubMed - NCBI [Internet]. [cité 27 déc 2018]. Disponible sur: https://www.ncbi.nlm.nih.gov/pubmed/17023848

  1. Liu K, Hsu CC, Chia YY. Effect of dexamethasone on postoperative emesis and pain. Br J Anaesth. janv 1998;80(1):85‑
  2. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. févr 2013;110(2):191‑
  3. Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. nov 1999;83(5):772‑
  4. Roach JT, Sufka KJ. Characterization of the chick carrageenan response. Brain Res. 24 déc 2003; 994(2): 216‑
  5. Methylprednisolone and ketorolac rapidly reduce hyperalgesia around a skin burn injury and increase pressure pain thresholds. - PubMed - NCBI [Internet]. [cité 27 déc 2018]. Disponible sur: https://www.ncbi.nlm.nih.gov/pubmed/17714578
  6. Xie W, Luo S, Xuan H, Chou C, Song G, Lv R, et al. Betamethasone affects cerebral expressions of

 

NF-kappaB and cytokines that correlate with pain behavior in a rat model of neuropathy. Ann Clin Lab Sci. 2006;36(1):39‑46.

  1. Role of lipocortin-1 in the anti-hyperalgesic actions of dexamethasone. - PubMed - NCBI [Internet]. [cité 27 déc 2018]. Disponible sur: https://www.ncbi.nlm.nih.gov/pubmed/9222544
  2. Barnes PJ. Molecular Mechanisms and Cellular Effects of Glucocorticosteroids. Immunology and Allergy Clinics of North America. août 2005; 25(3): 451‑
  3. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. sept 2011;115(3):575‑
  4. Ahn JH, Kim MR, Kim KH. Effect of i.v. dexamethasone on postoperative dizziness, nausea and pain during canal wall-up mastoidectomy. Acta Otolaryngol. nov 2005;125(11):1176‑
  5. Fujii Y, Nakayama M. Dexamethasone for the reduction of postoperative nausea and vomiting and analgesic requirements after middle ear surgery in adult Japanese patients. Methods Find Exp Clin Pharmacol. juin 2009;31(5):337‑
Iranian Journal of Otorhinolaryngology
Volume 34, Issue 6
November and December 2022
Pages 275-280

Files

Share

How to cite

Statistics