European Journal of Cardiovascular Medicine

Postoperative pain and edema are significant concerns following surgical procedures, impacting not only patient comfort but also the overall recovery process and length of hospital stay. Effective management of these symptoms is critical in enhancing postoperative outcomes and improving the quality of care. Traditionally, analgesics and anti-inflammatory drugs have been employed to mitigate these effects; however, each class of drug has its own limitations in terms of efficacy, side effects, and patient tolerability (1).

Corticosteroids, particularly dexamethasone, have gained attention for their potent anti-inflammatory and immunosuppressive properties. Dexamethasone, a synthetic glucocorticoid, inhibits the release of pro-inflammatory mediators such as prostaglandins and cytokines, thereby reducing tissue inflammation and vascular permeability (2,3). It is also known to reduce peripheral nociceptive sensitization, which contributes to pain control in the immediate postoperative period (4). Several studies have demonstrated that a single dose of intravenous dexamethasone administered preoperatively can significantly reduce the incidence and severity of postoperative nausea and vomiting (5,6). More recently, its role in reducing postoperative pain and swelling has been investigated in various surgical settings including oral and maxillofacial, orthopedic, and abdominal surgeries (7,8).

The timing and dosing of dexamethasone administration remain crucial in maximizing its therapeutic benefits while minimizing potential side effects such as hyperglycemia or delayed wound healing (9). A single preoperative dose is often preferred due to its simplicity, cost-effectiveness, and reduced risk of adverse effects when compared to multiple-dose regimens (10).

This study aims to assess the efficacy of a single preoperative intravenous dose of dexamethasone in reducing postoperative pain and edema in patients undergoing elective surgeries under general anesthesia, thereby contributing to the optimization of perioperative care protocols.

60 patients aged between 18 and 60 years scheduled for elective surgeries under general anesthesia were enrolled. The inclusion criteria comprised American Society of Anesthesiologists (ASA) physical status I and II patients undergoing elective surgeries. Patients with a history of chronic steroid use, diabetes mellitus, immunosuppressive disorders, peptic ulcer disease, or known allergy to corticosteroids were excluded.

Randomization and Blinding
Participants were randomly allocated into two equal groups (n=30 each) using a computer-generated random number table. Group A received 8 mg of intravenous dexamethasone diluted in 5 mL of normal saline, while Group B received 5 mL of intravenous normal saline as a placebo. The injections were administered 30 minutes prior to surgical incision. Both patients and the healthcare providers involved in administering the intervention and evaluating the outcomes were blinded to group allocation.

Anesthetic Protocol
All patients received standardized anesthetic management. Induction was achieved using intravenous propofol (2 mg/kg) and fentanyl (2 μg/kg), followed by muscle relaxation with vecuronium bromide (0.1 mg/kg). Anesthesia was maintained using isoflurane in oxygen and nitrous oxide, with controlled ventilation. Postoperative analgesia included paracetamol 1 g IV every 8 hours, and rescue analgesia with diclofenac 75 mg IM was administered if VAS > 4.

 Outcome Measures
Pain intensity was assessed using the Visual Analog Scale (VAS) ranging from 0 (no pain) to 10 (worst imaginable pain) at 6, 12, and 24 hours postoperatively. Facial edema was measured using standardized facial linear measurements at three reference points (tragus to pogonion, gonion to outer canthus, and tragus to outer canthus) at baseline (preoperative), and postoperatively at 24 and 48 hours. The mean of the three measurements was recorded as the edema score.

Statistical Analysis
Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY). Continuous variables were expressed as mean ± standard deviation. Intergroup comparisons were performed using the independent t-test, while repeated measures analysis was used for intragroup comparisons. A p-value of less than 0.05 was considered statistically significant.

A total of 60 patients were included in the final analysis, with 30 participants in each group. The demographic characteristics such as age, gender, and duration of surgery were comparable between Group A (dexamethasone) and Group B (placebo), with no statistically significant differences observed (Table 1).

Postoperative pain was significantly lower in the dexamethasone group across all time intervals. At 6 hours post-surgery, the mean VAS score was 3.2 ± 0.8 in Group A, compared to 5.4 ± 1.1 in Group B. At 12 hours, pain scores were 2.5 ± 0.7 and 4.7 ± 1.0, respectively, while at 24 hours, scores were 1.7 ± 0.5 in Group A versus 3.9 ± 0.9 in Group B (p<0.001 across all intervals) (Table 2).

Edema was evaluated using the average of three facial linear measurements. At 24 hours postoperatively, Group A showed a mean edema increase of 3.5 ± 1.2 mm compared to 6.8 ± 1.6 mm in Group B. By 48 hours, edema had decreased to 1.2 ± 0.7 mm in the dexamethasone group and 3.7 ± 1.0 mm in the placebo group, showing statistically significant differences between the groups (Table 3).

Overall, patients who received a single preoperative dose of dexamethasone reported significantly lower pain and reduced postoperative swelling at all measured intervals (Tables 2 and 3).

Table 1: Demographic and Surgical Characteristics of Participants

Table 2: Postoperative Pain Scores (VAS) at Different Time Intervals

Table 3: Postoperative Facial Edema Measurements (mm Increase from Baseline)

As illustrated in Tables 2 and 3, dexamethasone provided superior control over postoperative pain and edema compared to placebo throughout the evaluated period.

The results of this study demonstrate that a single preoperative dose of intravenous dexamethasone significantly reduces both postoperative pain and edema in patients undergoing elective surgeries under general anesthesia. These findings align with a growing body of literature supporting the analgesic and anti-inflammatory efficacy of corticosteroids in perioperative settings.

Dexamethasone, a long-acting glucocorticoid, exerts its effects by inhibiting phospholipase A2 and consequently reducing the production of pro-inflammatory mediators such as prostaglandins and leukotrienes (1,2). Its ability to suppress cytokine release also contributes to diminished tissue inflammation and capillary permeability, which are primary contributors to postoperative edema and pain (3). In the present study, patients who received dexamethasone reported significantly lower pain scores at all observed time intervals (Table 2), which is consistent with previous trials conducted in maxillofacial and orthopedic procedures (4,5).

A meta-analysis by De Oliveira et al. (6) reported that perioperative dexamethasone administration resulted in significant pain relief and reduced analgesic consumption within the first 24 hours post-surgery. Similarly, Elhakim et al. (7) observed that dexamethasone administration prior to tonsillectomy significantly minimized postoperative discomfort and improved patient satisfaction. Our study confirms these findings and extends the applicability of dexamethasone to broader surgical disciplines.

The reduction in facial edema observed in the dexamethasone group is particularly noteworthy. Edema is often associated with delayed healing, discomfort, and functional limitations, especially in head and neck surgeries (8). Dexamethasone reduces local inflammatory responses and stabilizes endothelial barriers, thereby mitigating fluid leakage and tissue swelling (9,10). Previous studies have documented similar outcomes, such as in third molar surgery (11), rhinoplasty (12), and orthopedic trauma (13), where a single corticosteroid dose was associated with faster recovery and improved postoperative appearance.

An important consideration in corticosteroid use is its safety profile. While chronic administration may result in complications such as hyperglycemia, immunosuppression, and delayed wound healing (14), multiple studies—including our own—support the safety of single-dose regimens with no significant adverse effects (15). None of the participants in our trial reported delayed healing or postoperative infections, aligning with other findings that short-term dexamethasone use is clinically safe and well-tolerated (16).

The timing and dosage of dexamethasone also play a critical role. Studies suggest that administration 30–60 minutes prior to incision yields optimal anti-inflammatory effects, with dosages ranging between 4 to 10 mg proving effective without significant side effects (17,18). In this study, 8 mg was chosen based on prior evidence indicating maximal benefit within this range (19).

While our results are promising, this study is not without limitations. The sample size was relatively small, and the findings are limited to short-term postoperative outcomes. Larger, multicenter studies with longer follow-up periods are necessary to evaluate long-term benefits and safety. Moreover, this study did not account for variations in individual pain perception or surgical complexity, which may influence outcomes

In conclusion, preoperative administration of a single dose of intravenous dexamethasone significantly reduces postoperative pain and edema, supporting its integration into standard anesthetic protocols for elective surgeries. Its cost-effectiveness, ease of use, and favorable safety profile make it an attractive adjunct in perioperative care.

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