Reduction of pain and swelling by a corticosteroid injected 3 hours after surgery

A main reason for investigating the clinical effects and possible merits of post-operative corticosteroid administration was its practical implications in traumatology. It was also hoped to obtain information relevant to the analgesic activity of steroid. A crossover study has been done in 12 healthy subjects, each of whom had two separate, but identical operations for removal of non-erupted 3rd molar teeth on each side of the jaw. 3 h after surgery, either betamethasone 9 mg (Celeston Chronodose) or placebo was injected intramuscularly in a randomized fashion. A paired comparison was made of the post-operative courses. All but 1 patient experienced less pain after the steroid injection. Surprisingly, some patients reported pronounced relief within min after the injection, whereas in others there was a time-lag. Swelling, measured on the 3rd day, was reduced by 47% after the steroid as compared to placebo. There was poor agreement between the steroid-induced reductions in pain and swelling. This exemplifies the dissociation between pain and other inflammatory events, and indicates that the analgesic and anti-inflammatory properties of a steroid may depend on discrete mechanisms, which may show considerable individual variation. From overall assessment, all 12 patients favoured the post-operative course when the steroid was administered. Almost the same levels of pain relief, reduction in swelling, and preference were reached in the present patients, who received the steroid 3 h post-operatively, as had previously been found in a similar trial in which the drug was injected prior to surgery. The results suggest that short term corticosteroid administration may be a valuable means of reducing pain and excessive inflammatory response after surgical or accidental soft tissue/bone injury.