Dexamethasone and persistent wound pain: a prespecified analysis of the randomised Perioperative Administration of Dexamethasone and Infection (PADDI) trial.

Humans Dexamethasone Surgical Wound Analgesics / therapeutic use Chronic Pain / drug therapy Postoperative Nausea and Vomiting Pain, Postoperative / drug therapy Double-Blind Method
analgesia chronic postsurgical pain dexamethasone glucocorticoid patient-centred outcome

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
07 2023
Historique:
received: 16 01 2023
revised: 14 03 2023
accepted: 27 03 2023
medline: 20 6 2023
pubmed: 26 5 2023
entrez: 25 5 2023
Statut: ppublish

Résumé

Dexamethasone is commonly administered intraoperatively to prevent postoperative nausea and vomiting and is believed to have analgesic properties. It is unknown whether it has an impact on chronic wound pain. In this prespecified embedded superiority substudy of the randomised PADDI trial, patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or placebo intravenously after induction of anaesthesia, and were followed up for 6 months postoperatively. The primary outcome was the incidence of pain in the surgical wound at 6 months. Secondary outcomes included acute postoperative pain and correlates of chronic postsurgical pain. We included 8478 participants in the modified intention-to-treat population (4258 in the dexamethasone group and 4220 in the matched placebo group). The primary outcome occurred in 491 subjects (11.5%) in the dexamethasone arm and 404 (9.6%) subjects in the placebo arm (relative risk 1.2, 95% confidence interval 1.06-1.41, P=0.003). Maximum pain scores at rest and on movement in the first 3 postoperative days were lower in the dexamethasone group compared with the control group {median 5 (inter-quartile range [IQR] 3.0-8.0) vs 6 (IQR 3.0-8.0) and median 7 (IQR 5.0-9.0) vs 8 (IQR 6.0-9.0), P<0.001 for both}. Severity of postoperative pain was not predictive of chronic postsurgical pain. The severity of chronic postsurgical pain and the frequency of neuropathic features did not differ between treatment groups. Administration of dexamethasone 8 mg i.v. was associated with an increase in the risk of pain in the surgical wound 6 months after surgery. ACTRN12614001226695.

Sections du résumé

BACKGROUND
Dexamethasone is commonly administered intraoperatively to prevent postoperative nausea and vomiting and is believed to have analgesic properties. It is unknown whether it has an impact on chronic wound pain.
METHODS
In this prespecified embedded superiority substudy of the randomised PADDI trial, patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or placebo intravenously after induction of anaesthesia, and were followed up for 6 months postoperatively. The primary outcome was the incidence of pain in the surgical wound at 6 months. Secondary outcomes included acute postoperative pain and correlates of chronic postsurgical pain.
RESULTS
We included 8478 participants in the modified intention-to-treat population (4258 in the dexamethasone group and 4220 in the matched placebo group). The primary outcome occurred in 491 subjects (11.5%) in the dexamethasone arm and 404 (9.6%) subjects in the placebo arm (relative risk 1.2, 95% confidence interval 1.06-1.41, P=0.003). Maximum pain scores at rest and on movement in the first 3 postoperative days were lower in the dexamethasone group compared with the control group {median 5 (inter-quartile range [IQR] 3.0-8.0) vs 6 (IQR 3.0-8.0) and median 7 (IQR 5.0-9.0) vs 8 (IQR 6.0-9.0), P<0.001 for both}. Severity of postoperative pain was not predictive of chronic postsurgical pain. The severity of chronic postsurgical pain and the frequency of neuropathic features did not differ between treatment groups.
CONCLUSION
Administration of dexamethasone 8 mg i.v. was associated with an increase in the risk of pain in the surgical wound 6 months after surgery.
CLINICAL TRIAL REGISTRATION
ACTRN12614001226695.

Identifiants

DOI: 10.1016/j.bja.2023.03.031 PMID: 37230849
pubmed: 37230849
pii: S0007-0912(23)00177-0
doi: 10.1016/j.bja.2023.03.031
pii:
doi:

Substances chimiques

Dexamethasone 7S5I7G3JQL
Analgesics 0

Types de publication

Randomized Controlled Trial Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

93-103

Commentaires et corrections

Type : CommentIn

Informations de copyright

Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.

Auteurs

Tomás B Corcoran (TB)

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. Electronic address: tomas.corcoran@health.wa.gov.au.

Catherine Martin (C)

Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.

Edmond O'Loughlin (E)

Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Fiona Stanley Hospital, Perth, Western Australia, Australia.

Kwok Ho (K)

Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Veterinary and Life sciences, Murdoch University, Perth, Western Australia, Australia.

Matthew Chan (M)

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Special Administrative Region, China.

Andrew Forbes (A)

Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.

Kate Leslie (K)

Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia.

Paul Myles (P)

Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › Composés polycycliques › Composés à cycles fusionnés › Stéroïdes › Stéroïdes fluorés › Dexaméthasone › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › Plaies et blessures › Plaie opératoire › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Analgésiques › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur chronique › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Signes et symptômes digestifs › Vomissement › Vomissements et nausées postopératoires › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur postopératoire › Dexamethasone and persistent wound pain: a...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méthode en double aveugle › Dexamethasone and persistent wound pain: a...