The Anti-inflammatory Effects of Perioperative Dexamethasone Administration and the Relationship to Pain: A Systematic Review and Meta-analysis
Authors: Klecha Tyler , Gericke Ryan , Al-Shehab Usmaan , Dougherty Jaime , Atlas Glen 
Published: January 2025

Introduction: Post-surgical inflammation is a common adverse event that can have detrimental effects on the recovery phase for patients. Commonly associated with pain severity, inflammation can make the management of postoperative pain difficult. Of the multiple inflammatory molecules that can be found in an inflammatory response, interleukin 6 (IL-6) and C-reactive protein (CRP) are two of the most commonly assayed biomarkers of inflammation. Dexamethasone (DEX), with its anti-inflammatory properties, is thought to reduce IL-6 and CRP. It thus may reduce pain when administered perioperatively. In this review, we assessed the anti-inflammatory effects of DEX and the relationship of such effects in the management of postoperative pain.

Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials using the following criteria: patients greater than or equal to eighteen years of age undergoing surgery. The intervention of interest is perioperative DEX administration and the control was normal saline or the absence of DEX administration. Primary outcomes included postoperative IL-6 and CRP levels, with a secondary outcome of postoperative pain scores. Utilizing the RevMan program, a meta-analysis was performed using a random effect model. Studies not able to be analyzed quantitatively were assessed through a narrative approach.

Results: We identified a total of nine studies with 1048 subjects which fulfilled inclusion criteria. Only three of the nine studies were able to be quantitatively analyzed. Our analysis of these studies favored DEX administration for the reduction of postoperative inflammation with regard to IL-6 (SMD = -1.88; 95% CI -2.28 - 1.48; p < 0.01; Figure 3a), and near significant difference with regard to CRP (SMD = -0.93; 95% CI -1.91 - 0.04; p = 0.06; Figure 3b). DEX administration was also shown to significantly reduce postoperative pain (SMD = -1.34; 95% CI -2.12 - -0.56; p < 0.01; Figure 3c). Qualitative analysis for eight of the nine studies favored the administration of DEX for the reduction of inflammation as well as postoperative pain. The total dosage of DEX administered ranged from 6.6 to 40 mg. Regarding complications after DEX administration, all nine studies reported no significant increase in the incidence of serious adverse effects, including hyperglycemia, surgical site infections, or impaired wound healing.

Conclusion: Dexamethasone is a commonly used medication for the management of postoperative nausea and vomiting. Additionally, administration of DEX perioperatively also appears to be efficacious in lowering inflammation and managing postoperative pain from various types of surgical procedures. Complications, including impaired wound healing, hyperglycemia, and surgical site infections, which have been reported in previous studies, have not been observed with significance with the administration of one or two doses of DEX as evidenced by the literature in this review. Further research may justify the utilization of DEX as a means to reduce postoperative inflammation and subsequent pain.