Post-operative of pain is one of the commonest complications of surgery and has been, for a long time, managed by use of analgesics, especially Non-Steroidal Anti-inflammatory Drugs (NSAIDS). The result of the pain is due to the neuroendocrine and immunological response to the iatrogenic tissue damage that occurs during surgery. Inflammatory mediators released by the immunological cells initiate a cascade of systemic events, thus worsening the pain. Given the immune-modulatory effects of steroids, one would expect that steroids alleviate post-surgical pain. However, these drugs are rarely used to control acute surgical pain. This paper seeks to discuss the existing evidence on the use of post-operative steroids.
Steroids inhibit the peripheral action of phospholipase, thus limiting the systemic pain causing pathways that are mediated by cyclooxygenase and lipoxygenase. Additionally, these drugs reduce the expression of molecules such as bradykinin, interleukins 1, 6 and 8 and leukocyte adhesion molecules ( Mohammad et al, 2017, p. 92) .
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Despite having the potential to reduce the inflammatory response that causes surgical pain, the timing for administration of the drugs presents a challenge because of their delayed onset of action. Steroids trigger gene expression and protein synthesis for their action, which may take longer time than the post-operative pain itself. Evidence continues to suggest that steroids offer short-term effects in the control of acute pain (Turan and Sessler, 2011, p. 458). Additionally, the same mechanisms of steroids that reduce the inflammation after surgery could increase the risk of post-operative systemic infection. Their use also leads to a greater risk of surgical site infection. Steroids also have a hyperglycemic effect , a complication that may worsen post-operative outcome ( Mohammad et al, 2017, p. 92) .
In conclusion, routine use of steroids to control post-operative pain is uncommon. The drugs offer some benefit in control of the pain, but their use should exist in consideration of risks and benefits. Due to their delayed onset of action, evidence continues to suggest that perioperative administration of dexamethasone may be more effective than administration after surgery. Opioids are more superior and more effective in the control of acute surgical compared to steroids.
References
Mohammad, H. R., Trivella, M., Hamilton, T. W., Strickland, L., Murray, D., & Pandit, H. (2017). Perioperative adjuvant corticosteroids for post-operative analgesia in elective knee surgery–A systematic review. Systematic Reviews , 6 (1), 92. Retrieved From: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-017-0485-8
Turan, A., & Sessler, D. I. (2011). Steroids to ameliorate postoperative pain. The Journal of the American Society of Anesthesiologists , 115 (3), 457-459. Retrieved From: http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1934124
