Does Intra-Operative IV Dexamethasone Reduce Postoperative Pain More Effectively With Nonopioids or Opioids?

Corticosteroids reduce postoperative swelling and trismus. However, their role in pain management, particularly when combined with opioid versus nonopioid analgesics, is less understood.

The purpose of the study was to determine whether intra-operative corticosteroids reduce postoperative pain following third molar surgery and compare its effect on pain relief within nonopioid (NSAIDs and acetaminophen) and opioid analgesic treatment arms.

This retrospective cohort study is based on the multicenter Opioid Analgesic Reduction Study (OARS) (n = 1,815). Participants who received oral corticosteroids (n = 41) were excluded.

The primary predictor was the therapeutic treatment (opioid, nonopioid). Within each treatment arm, participants were grouped based on intra-operative steroid use (steroid, no steroid).

Average pain (numeric rating scale: 0 to 10) was measured on postoperative days 1, 2, and 3 and entire postoperative period. Secondary outcomes included satisfaction with pain medication, unused analgesic tablets, use of rescue opioids, and emergency clinic visits.

Covariates included age, sex, race/ethnicity, preoperative pain and swelling, number of teeth extracted, impaction level, anesthesia type, use of antibiotics, and the administration of 0.5% bupivacaine with 1:200,000 epinephrine.

Mixed-effects models estimated the interaction of analgesics by steroid use by time with random effects for study sites and participants. Differences were assessed using P < .00625 to account for multiple comparisons.

The sample included 1,774 subjects with a mean age (SD) of 25.7(6.2) and 893(50.3%) were female. Analgesics by steroid groups were distributed as follows: nonopioid + no-steroid (626(35.3%)), opioid + no-steroid (635(35.8%)), nonopioid + steroid (265(14.9%)), and opioid + steroid (248(14.0%)). Steroid exposure was associated with lower day 1 postoperative pain in both the nonopioid group (mean difference 0.78; 99.375% CI 0.25 to 1.30; P < .001) and the opioid group (1.22; 0.68 to 1.77; P < .001). Across all days, the nonopioid + steroid group had the lowest pain scores, with a mean difference of 0.55 (-0.04 to 1.14; P = .026) compared with the nonopioid+ no steroid group.

Intra-operative IV dexamethasone was associated with reduced pain for the first 24 hours following third molar surgery. Adding dexamethasone to either analgesic group improved pain control. Providers should consider incorporating intra-operative IV dexamethasone with postoperative nonsteroidal anti-inflammatory drugs and acetaminophen.