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 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double‐blind, placebo‐controlled clinical trial was conducted at H orsens R egional H ospital, D enmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure ( n  = 101) were randomised to receive intravenous dexamethasone 40 mg ( D 40), 8 mg ( D 8) or placebo ( D 0) before surgery. The primary outcome was pain intensity 8 h 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: ( D 40: 25, D 8: 26, D 0: 22 patients). Eight hours after surgery, pain intensity were: [median (interquartile range)] group D 40: 2 (1–4), group D 8: 2.5 (1–5), group D 0: 4 (2–7). There was no significant difference in pain intensity between group D 40 and D 8 after 8 h ( 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 8 h 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 40 mg did not improve analgesia significantly after outpatient shoulder surgery.