Methylprednisolone (Surgical — Anti-Inflammatory)

How it works

It binds glucocorticoid receptors to modulate gene transcription, suppressing the synthesis of inflammatory mediators and reducing oedema, capillary permeability and the inflammatory response.

Prescribing in practice

• Corticosteroids impair wound healing, raise blood glucose and increase infection risk, so weigh these against benefit, screen for active infection, and never stop chronic corticosteroid therapy abruptly because of adrenal suppression.
• Use the lowest effective dose for the shortest period; rapid intravenous administration of large doses has been associated with cardiovascular effects and should be given slowly.
• Provide stress-dose cover for patients on long-term steroids undergoing surgery, and arrange a taper rather than abrupt withdrawal after prolonged courses.

Monitoring

Monitor blood glucose, blood pressure, signs of infection and wound healing, with consideration of adrenal function after prolonged or high-dose use.

Counselling the patient

• Explain a steroid is being used to reduce inflammation and swelling around your operation.
• If you take steroids regularly, do not stop them suddenly and carry your steroid card.

Evidence & guidelines

Methylprednisolone is a well-established corticosteroid; perioperative use is guided by the SPC and surgical practice, balancing anti-inflammatory benefit against effects on healing, glycaemia and infection.