Dexamethasone does not reduce pain or analgesic consumption after thyroid surgery; a prospective, randomized trial

Background: Post-operative analgesic effect of a perioperative fixed dose glucocorticoid has been demonstrated in studies on different surgical procedures. The aim of this study was to look for analgesic and opioid sparing effect after thyroid surgery with a weight-adjusted medium dose of dexamethasone compared with placebo or a higher dose. Further, to register other effects and side effects of dexamethasone in the 0-30 days postoperative period. Methods: One hundred and twenty patients scheduled for thyroid surgery were randomly assigned to three groups receiving either dexamethasone 0.30 mg/kg, 0.15 mg/kg or placebo. Pain scores at rest and on coughing, post-operative nausea and vomiting ( PONV), consumption of opioids and anti-emetics, appetite, sleep pattern, fatigue, mood, blood sugar, wound infection and dyspepsia were recorded. Results: There was no effect of either dexamethasone doses on post-operative pain or rescue opioid consumption. PONV was lower in the dexamethasone groups 2-4 h post-operatively P < 0.01). Blood sugar increased moderately from baseline in all groups, but significantly more in the dexamethasone groups ( P < 0.01 at 2 h and P < 0.001 at 4 h). Minor improvement in appetite was shown with dexamethasone, along with a tendency towards less sleep and more fatigue in the 3- 30 days period for the higher dose. No effect was demonstrated on other parameters. Conclusion: Dexamethasone had no analgesic or opioid sparing effect in our set- up after thyroid surgery. Dexamethasone reduced the incidence of PONV and led to a modest increase in blood sugar. A medium dose seems as effective as a higher dose.