The Effect of Dexamethasone on Pain Severity After Zygomatic Complex Fractures.

The authors sought to assess the effect of systemic perioperative dexamethasone (DXM) on pain severity after zygomatic complex (ZC) fracture surgery. To achieve this, the authors conducted a prospective randomized observer-blinded trial on 63 patients with isolated ZC fracture requiring surgical intervention. Patients randomly received either perioperative systemic DXM (10 or 30 mg), or served as controls receiving no DXM, and postoperative pain severity was assessed. Pain was measured with a 10 cm visual analogue scale (VAS) each time that analgesics (1 g paracetamol 4 times daily or oxycodone upon request) were administered, and analyzed as the area under the VAS curve for the immediate postoperative 24 hours. This further divided experienced pain into 2 categories (mild, or moderate to severe) using VAS = 4 as the cutoff. For statistics the authors used x 2 test, Mann-Whitney U test, and logistic regression analysis, setting significance at P< 0.05. Zygomatic complex fracture patients receiving perioperative systemic DXM experienced milder pain compared with controls (P = 0.04). Subgroups receiving DXM (10 or 30 mg) reported no statistical difference regarding pain (P = 0.43). Overall, patients receiving DXM experienced less pain, thus DXM may be recommended as pre-emptive analgesic. Nonetheless, considering the possible adverse effects, a 10mg single dose may be sufficient.