PMID- 37230849
OWN - NLM
STAT- MEDLINE
DCOM- 20230620
LR  - 20230620
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Linking)
VI  - 131
IP  - 1
DP  - 2023 Jul
TI  - Dexamethasone and persistent wound pain: a prespecified analysis of the 
      randomised Perioperative Administration of Dexamethasone and Infection (PADDI) 
      trial.
PG  - 93-103
LID - S0007-0912(23)00177-0 [pii]
LID - 10.1016/j.bja.2023.03.031 [doi]
AB  - BACKGROUND: Dexamethasone is commonly administered intraoperatively to prevent 
      postoperative nausea and vomiting and is believed to have analgesic properties. 
      It is unknown whether it has an impact on chronic wound pain. METHODS: In this 
      prespecified embedded superiority substudy of the randomised PADDI trial, 
      patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or 
      placebo intravenously after induction of anaesthesia, and were followed up for 6 
      months postoperatively. The primary outcome was the incidence of pain in the 
      surgical wound at 6 months. Secondary outcomes included acute postoperative pain 
      and correlates of chronic postsurgical pain. RESULTS: We included 8478 
      participants in the modified intention-to-treat population (4258 in the 
      dexamethasone group and 4220 in the matched placebo group). The primary outcome 
      occurred in 491 subjects (11.5%) in the dexamethasone arm and 404 (9.6%) subjects 
      in the placebo arm (relative risk 1.2, 95% confidence interval 1.06-1.41, 
      P=0.003). Maximum pain scores at rest and on movement in the first 3 
      postoperative days were lower in the dexamethasone group compared with the 
      control group median 5 (inter-quartile range [IQR] 3.0-8.0) vs 6 (IQR 3.0-8.0) 
      and median 7 (IQR 5.0-9.0) vs 8 (IQR 6.0-9.0), P<0.001 for both. Severity of 
      postoperative pain was not predictive of chronic postsurgical pain. The severity 
      of chronic postsurgical pain and the frequency of neuropathic features did not 
      differ between treatment groups. CONCLUSION: Administration of dexamethasone 8 mg 
      i.v. was associated with an increase in the risk of pain in the surgical wound 6 
      months after surgery. CLINICAL TRIAL REGISTRATION: ACTRN12614001226695.
CI  - Crown Copyright (c) 2023. Published by Elsevier Ltd. All rights reserved.
FAU - Corcoran, Tomas B
AU  - Corcoran TB
AD  - Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western 
      Australia, Australia; Discipline of Emergency Medicine, University of Western 
      Australia, Perth, Western Australia, Australia; Central Clinical School, Faculty 
      of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 
      Australia. Electronic address: tomas.corcoran@health.wa.gov.au.
FAU - Martin, Catherine
AU  - Martin C
AD  - Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash 
      University, Melbourne, VIC, Australia.
FAU - O'Loughlin, Edmond
AU  - O'Loughlin E
AD  - Discipline of Emergency Medicine, University of Western Australia, Perth, Western 
      Australia, Australia; Department of Anaesthesia, Fiona Stanley Hospital, Perth, 
      Western Australia, Australia.
FAU - Ho, Kwok
AU  - Ho K
AD  - Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western 
      Australia, Australia; Discipline of Emergency Medicine, University of Western 
      Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Fiona 
      Stanley Hospital, Perth, Western Australia, Australia; School of Veterinary and 
      Life sciences, Murdoch University, Perth, Western Australia, Australia.
FAU - Chan, Matthew
AU  - Chan M
AD  - Department of Anaesthesia and Intensive Care, The Chinese University of Hong 
      Kong, Special Administrative Region, China.
FAU - Forbes, Andrew
AU  - Forbes A
AD  - Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash 
      University, Melbourne, VIC, Australia.
FAU - Leslie, Kate
AU  - Leslie K
AD  - Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash 
      University, Melbourne, VIC, Australia; Department of Critical Care, Melbourne 
      Medical School, University of Melbourne, Melbourne, VIC, Australia; Department of 
      Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, 
      Australia.
FAU - Myles, Paul
AU  - Myles P
AD  - Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash 
      University, Melbourne, VIC, Australia; Department of Anaesthesia and 
      Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20230523
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - 0 (Analgesics)
SB  - IM
CIN - Br J Anaesth. 2023 Jul;131(1):8-10. PMID: 37183100
MH  - Humans
MH  - Dexamethasone
MH  - *Surgical Wound
MH  - Analgesics/therapeutic use
MH  - *Chronic Pain/drug therapy/prevention & control
MH  - Postoperative Nausea and Vomiting
MH  - Pain, Postoperative/drug therapy/prevention & control
MH  - Double-Blind Method
OTO - NOTNLM
OT  - analgesia
OT  - chronic postsurgical pain
OT  - dexamethasone
OT  - glucocorticoid
OT  - patient-centred outcome
EDAT- 2023/05/26 01:05
MHDA- 2023/06/20 06:42
CRDT- 2023/05/25 22:00
PHST- 2023/01/16 00:00 [received]
PHST- 2023/03/14 00:00 [revised]
PHST- 2023/03/27 00:00 [accepted]
PHST- 2023/06/20 06:42 [medline]
PHST- 2023/05/26 01:05 [pubmed]
PHST- 2023/05/25 22:00 [entrez]
AID - S0007-0912(23)00177-0 [pii]
AID - 10.1016/j.bja.2023.03.031 [doi]
PST - ppublish
SO  - Br J Anaesth. 2023 Jul;131(1):93-103. doi: 10.1016/j.bja.2023.03.031. Epub 2023 
      May 23.