Role of Dexamethasone in Reducing Pain after Endoscopic Sinus Surgery in Adults: A Double-Blind Prospective Randomized Trial

Abstract

Objectives: We sought to study postoperative pain after endoscopic sinus surgery and to evaluate the efficacy of dexamethasone sodium phosphate in reducing pain and rescue analgesic requirements. Methods: In a prospective, double-blind, placebo-controlled clinical trial, 62 patients with chronic rhinosinusitis who were undergoing general anesthesia for endoscopic sinus surgery were randomized to receive either 8 mg (2 mL) of intravenous dexamethasone sodium phosphate or 2 mL of saline solution at the time of induction of anesthesia. After surgery, the patients were observed for 24 hours and were given 1 g of acetaminophen every 6 hours. Pain severity was reported immediately and 6 and 24 hours after surgery on a 10-cm visual analog scale. The need for rescue analgesia with tramadol hydrochloride was recorded and compared between the two groups. Results: The two groups were matched by demographic data, clinical indications, and intraoperative details. The average postoperative pain severity scores at the 3 time intervals were 3.6, 2, and 1 in the dexamethasone group and 3.6, 2.5, and 1.6 in the saline solution group. These differences were not statistically significant. Ten patients in the dexamethasone group required rescue analgesia, compared to 12 in the saline solution group. The average patient required 0.53 doses of rescue analgesic in the dexamethasone group, versus 0.67 doses in the saline solution group. Again, these differences were not statistically significant. Conclusions: Dexamethasone injection at the time of induction of general anesthesia is not superior to placebo in controlling early postoperative pain in patients who undergo endoscopic sinus surgery.