Dexamethasone for pain after outpatient shoulder surgery: a randomised, double-blind, placebo-controlled trial

Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8mg. Methods A randomised, double-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n=101) were randomised to receive intravenous dexamethasone 40mg (D40), 8mg (D8) or placebo (D0) before surgery. The primary outcome was pain intensity 8h after surgery rated on a numeric rating scale of 0 to 10. Secondary outcomes were pain intensity, analgesic consumption and side effects during the first 3 days after surgery. Results Data from 73 patients were available for analysis: (D40: 25, D8: 26, D0: 22 patients). Eight hours after surgery, pain intensity were: [median (interquartile range)] group D40: 2 (1-4), group D8: 2.5 (1-5), group D0: 4 (2-7). There was no significant difference in pain intensity between group D40 and D8 after 8h (P=0.46) or at any other time. When comparing all three groups, a statistically significant dose-response relationship was seen for present, average and worst pain intensity after 8h and on the following morning. No differences were found in analgesic consumption. No serious side effects were observed. Conclusion Although our data supported a dose-response relationship, increasing the dexamethasone dose from 8 to 40mg did not improve analgesia significantly after outpatient shoulder surgery.