[Dexamethasone for Perioperative Analgesia]

Dexamethasone is a highly potent, long-acting synthetic glucocorticoid that does not exhibit any mineralocorticoid activity. It is commonly used during surgery to prevent postoperative nausea and vomiting (PONV), but also due to its perceived ability to reduce postoperative pain and the associated consumption of opioids.

To summarise the fundamentals relating to the substance, the clinically relevant forms of administration, the common dosages, the contraindications, the adverse effects and the guideline recommendations.

Parenteral preparations typically contain dexamethasone-21-dihydrogen phosphate, which has an anti-inflammatory potency approximately thirty times greater than that of cortisol. While higher dosages do not appear to offer a proportional additional benefit, single intravenous doses of 4-8 mg predominate in the literature. At these dosages, dexamethasone is considered safe. Notably, there are no increased rates of postoperative wound infections or delayed wound healing, although there is a mild, transient increase in blood glucose levels. However, specific risks exist in cases of haematological neoplasms due to tumour lysis syndrome, as well as in endocrinological diagnostics due to suppression of the hypothalamic-pituitary-adrenal axis. Current guidelines increasingly position dexamethasone as part of balanced analgesia strategies, sometimes involving repeat doses within ERAS protocols.

When the risk-benefit ratio is carefully considered, dexamethasone can contribute to postoperative analgesia as part of a balanced analgesia strategy.