Dexamethasone (Orthopaedic — PONV and Opioid-Sparing)

How it works

Dexamethasone is a potent long-acting glucocorticoid with anti-inflammatory and antiemetic actions mediated through glucocorticoid receptors; the antiemetic effect is thought to involve central and anti-inflammatory pathways while reduced inflammation aids analgesia.

Prescribing in practice

• A single perioperative dose can cause a transient rise in blood glucose, so monitor and manage glycaemia particularly in people with diabetes, and weigh use in poorly controlled diabetes.
• Give the intravenous dose slowly to avoid perineal irritation, and recognise that even a single dose can modestly affect wound healing and infection risk and may interact with the surgical antibiotic strategy.
• It is generally a one-off perioperative dose rather than a course; for any repeated or higher-dose corticosteroid use follow the SPC and steroid governance, and review interactions such as with NSAIDs increasing GI risk.

Monitoring

Monitor blood glucose perioperatively, especially in diabetic patients, after the single dose.

Counselling the patient

• You may receive a single steroid injection during your operation to help with sickness and pain.
• Your blood sugar may rise temporarily, particularly if you have diabetes, and may be checked.
• This is a one-off dose and does not require ongoing steroid tablets.

Evidence & guidelines

Randomised evidence and anaesthetic guidance support a single perioperative dose of dexamethasone to reduce PONV and post-operative opioid requirements.