IV Dexamethasone offers postoperative pain reduction in femoral neck fracture fixation

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
37 patients, over the age of 65 years, with a femoral neck fracture who were scheduled for operative fixation, were randomized to a preoperative IV dose of either dexamethasone 0.1mh/kg or placebo. The purpose of this study was to determine if preoperative dexamethasone led to a significant reduction in pain and opioid consumption over the first 3 days and 1 week after surgery. Scores for pain Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Department of Anaesthesia, Intensive Care and Pain Medicine, Cork University Hospital
Conflicts: None disclosed
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Why was this study needed now?
Femoral neck fractures are common among elderly patients presenting with trauma, necessitating surgical fixation. Preoperative low-dose dexamethasone has been suggested as a possible addition to multimodal analgesia regimens to improve postoperative analgesic efficacy. However, there have been concerns expressed relating to a possible increase in adverse events, particularly in such an age group.
What was the principal research question?
In the fixation of femoral neck fractures, does a preoperative IV dose of dexamethasone 0.1mg/kg result in significantly lower pain scores at 6 hours postoperatively when compared to placebo saline?
Population: 37 patients, over the age of 65, with a femoral neck fracture who were scheduled for operative fixation. All procedures were performed under spinal anesthesia. Postoperative analgesia included intravenous paracetamol 1g every 6 hours, and intramuscular morphine 5-10mg for rescue analgesia.
Intervention: Dexamethasone group: Within the operating room prior to surgery, patients were administered intravenously, dexamethasone 0.1mg/kg.
Comparison: Placebo group: Within the operating room prior to surgery, patients were administered intravenously, placebo saline.
Outcomes: The primary outcome measure was pain on a numeric rating scale (NRS; 0-10), both at rest and on movement. Secondary outcomes included analgesic consumption and incidence of nausea/vomiting, sedation, and pruritus.
Methods: RCT
Time: Patients were assessed at 6h (primary endpoint), 12h, 24h, 48h, 72h, and 1 week postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.