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Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgery.

Author(s): Mattila K, Kontinen VK, Kalso E, Hynynen MJ

Affiliation(s): Department of Anesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, 00029 HUS Finland. kristiina.mattila@hus.fi

Publication date & source: 2010-03, Acta Anaesthesiol Scand., 54(3):268-76. Epub 2009 Oct 10.

Publication type: Randomized Controlled Trial

BACKGROUND: Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. METHODS: Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented. RESULTS: Twenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0-165) mg in the dexamethasone group and 78 (15-175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0-1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0-1, and significantly less nausea on POD 1. On PODs 2-3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ - in both groups 81% would have chosen the same medication again. CONCLUSION: Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus.

Page last updated: 2010-10-05

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