The Journal of Bone and Joint Surgery (American). 2006;88:1361-1372.
doi:10.2106/JBJS.D.03018
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Current Concepts Review

Efficacy and Safety of Steroid Use for Postoperative Pain Relief

Update and Review of the Medical Literature

Angelo Salerno, Dip App Sc, Grad Dip, MPod (Pod Surg)1 and Robert Hermann, DPS2

1 130 Stephen Terrace, Gilberton, SA 5081, Australia. E-mail address: footmed{at}bigpond.net.au
2 174 Hancock Road, Ridgehaven, SA 5097, Australia. E-mail address: drherman{at}footandankle.com.au

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or non-profit organization with which the authors are affiliated or associated.

Despite the availability of various analgesic regimens, patient surveys have indicated that moderate-to-severe postoperative pain is still poorly managed.

The use of corticosteroids for postoperative pain relief, although popular, has yet to gain wider acceptance because of concerns over side effects, in particular adrenal suppression, osteonecrosis, impaired wound-healing, and concerns about efficacy. The medical literature provides evidence that should substantially decrease these concerns with regard to low and short-dose applications.

The results of randomized trials have shown low, short-dose corticosteroid regimens to be safe and effective for reducing postoperative pain.

There is strong, grade-A evidence supporting the use of corticosteroids in multimodal analgesia protocols to contribute to the postoperative recovery of the patient by minimizing opioid doses and therefore side effects. However, the optimal mode, dose, and timing of administration remain unclear.


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Letters to the Editor:

Read all Letters to the Editor

Steroid use for post-operative pain
Michael David McKee, M.D., FRCS(C)
JBJS Online, 25 Jul 2006 [Full text]
Intra-operative Administration of Corticosteroids by Irrigation for Pain Relief
George R. Cary, Jr., M.D.
JBJS Online, 20 Dec 2006 [Full text]
Dr. Salerno responds to Dr. Cary
Angelo Salerno, Dip App Sc, Grad Dip, Mpod
JBJS Online, 3 Jan 2007 [Full text]
Dr. Salerno responds to Dr. McKee
Angelo Salerno, Dip App Sc, Grad Dip, Mpod (Pod Surg)
JBJS Online, 3 Jan 2007 [Full text]