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Corticosteroid — Anti-emetic and Opioid-Sparing Pregnancy: Single dose for PONV — short-term use, low risk; consult anaesthetic team

Dexamethasone (Orthopaedic — PONV and Opioid-Sparing)

Brand names: Dexamethasone phosphate injection

Adult dose

Dose: 4–8 mg IV single dose intraoperatively (PONV prevention); 0.1–0.25 mg/kg for opioid-sparing in multimodal analgesia
Route: Intravenous
Frequency: Single dose intraoperatively (PONV); or post-operative dosing for pain
Max: 8 mg per dose for PONV prevention
PONV prevention: give 4–8 mg IV at induction. Opioid-sparing: higher doses (0.1–0.2 mg/kg) given intraoperatively reduce post-operative pain and opioid consumption. Single intraoperative dose rarely causes clinically significant cortisol suppression or hyperglycaemia — monitor blood glucose post-op in diabetic patients.

Paediatric dose

Dose: 0.15 mg/kg
Route: IV
Frequency: Single dose
Max: 8 mg
Paediatric PONV prophylaxis: 0.15 mg/kg IV at induction; highly effective in adenotonsillectomy and strabismus surgery

Dose adjustments

Renal

No dose adjustment required

Hepatic

No specific adjustment for single intraoperative dose

Paediatric weight-based calculator

Paediatric PONV prophylaxis: 0.15 mg/kg IV at induction; highly effective in adenotonsillectomy and strabismus surgery

Clinical pearls

  • PONV prevention: dexamethasone 4–8 mg IV is one of four standard PONV prevention interventions (with ondansetron, TIVA propofol, and droperidol) per Apfel PONV risk score and ERAS protocols
  • Single intraoperative dexamethasone dose does NOT clinically suppress adrenal function or increase infection risk — evidence from large RCTs; benefits outweigh risks in most patients
  • Diabetic patients: single dose dexamethasone 8 mg causes blood glucose to rise by 2–4 mmol/L peaking at 6–10 hours post-operatively — monitor blood glucose at 6 and 12 hours; treat with short-acting insulin if required
  • ERAS arthroplasty: dexamethasone 8 mg IV at induction is now standard in most ERAS-compliant THA/TKR protocols — reduces opioid requirements and PONV simultaneously
  • Perineal burning: rapid IV injection of dexamethasone phosphate causes a transient burning sensation in the perineum — slow infusion over 2–3 minutes prevents this; warn patients and staff

Contraindications

  • Systemic infection without antimicrobial cover
  • Poorly controlled diabetes (relative — monitor blood glucose)

Side effects

  • Hyperglycaemia — particularly in diabetic patients; peaks 6–10 hours post-dose
  • Impaired wound healing with repeated doses
  • Immunosuppression (minimal with single dose)
  • Perineal burning/flushing with rapid IV injection (phosphate ester formulation)

Interactions

  • Antidiabetics — blood glucose adjustment may be needed 6–10 hours post-dose
  • NSAIDs — additive GI risk if regular dexamethasone and NSAID co-prescribed
  • CYP3A4 inducers (rifampicin) — reduce dexamethasone levels

Monitoring

  • Blood glucose at 6–12 hours post-dose (diabetic patients)
  • Wound assessment post-operatively
  • PONV assessment

Reference: BNFc; BNF 90; Apfel PONV Score Guidelines; ERAS Society Arthroplasty Protocol; NICE NG180 (Perioperative Care); SPC Dexamethasone. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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