Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/35006
Title: Intraoperative dexamethasone and chronic postsurgical pain: a propensity score-matched analysis of a large trial.
Austin Authors: Myles, Paul S;Corcoran, Tomas B;Chan, Matthew T;Asghari-Jafarabadi, Mohammad;Wu, William K K;Peyton, Philip J ;Leslie, Kate;Forbes, Andrew
Affiliation: Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, VIC, Australia; Department of Anaesthesiology and Perioperative Medicine and Biostatistics Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
Department of Anaesthesia and Perioperative Medicine, Royal Perth Hospital, Perth, WA, Australia; Department of Pharmacology, University of Western Australia, Perth, WA, Australia.
Department of Anaesthesiology, The Chinese University of Hong Kong, Hong Kong.
Biostatistics Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
Department of Anaesthesiology, The Chinese University of Hong Kong, Hong Kong.
Anaesthesia
Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Critical Care, University of Melbourne, Parkville, VIC, Australia.
Biostatistics Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
Issue Date: 24-Jan-2024
Date: 2024
Publication information: British Journal of Anaesthesia 2024-01-24
Abstract: Dexamethasone has been shown to reduce acute pain after surgery, but there is uncertainty as to its effects on chronic postsurgical pain (CPSP). We hypothesised that in patients undergoing major noncardiac surgery, a single intraoperative dose of dexamethasone increases the incidence of CPSP. We devised a propensity score-matched analysis of the ENIGMA-II trial CPSP dataset, aiming to compare the incidence of CPSP in patients who had received dexamethasone or not 12 months after major noncardiac surgery. The primary outcome was the incidence of CPSP. We used propensity score matching and inverse probability weighting to balance baseline variables to estimate the average marginal effect of dexamethasone on patient outcomes, accounting for confounding to estimate the average treatment effect on those treated with dexamethasone. We analysed 2999 patients, of whom 116 of 973 (11.9%) receiving dexamethasone reported CPSP, and 380 of 2026 (18.8%) not receiving dexamethasone reported CPSP, unadjusted odds ratio 0.76 (95% confidence interval 0.78-1.00), P=0.052. After propensity score matching, CPSP occurred in 116 of 973 patients (12.2%) receiving dexamethasone and 380 of 2026 patients (13.8%) not receiving dexamethasone, adjusted risk ratio 0.88 (95% confidence interval 0.61-1.27), P=0.493. There was no difference between groups in quality of life or pain interference with daily activities, but 'least pain' (P=0.033) and 'pain right now' (P=0.034) were higher in the dexamethasone group. Dexamethasone does not increase the risk of chronic postsurgical pain after major noncardiac surgery. Open Science Framework Registration DOI https://doi.org/10.17605/OSF.IO/ZDVB5.
URI: https://ahro.austin.org.au/austinjspui/handle/1/35006
DOI: 10.1016/j.bja.2023.12.031
ORCID: 
Journal: British Journal of Anaesthesia
PubMed URL: 38267338
ISSN: 1471-6771
Type: Journal Article
Subjects: anaesthesiology
corticosteroids
dexamethasone
pain
quality of life
surgery
Appears in Collections:Journal articles

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