The effect of intravenous dexamethasone on post-operative pain and swelling following periodontal flap surgery: A randomized controlled trial of patient centered outcomes.

BACKGROUND This randomized, crossover trial sought to determine if a pre-operative intravenous (IV) dose of dexamethasone reduces pain, swelling and analgesic usage following periodontal surgery. METHODS Thirty-seven patients planned for two similar periodontal flap surgeries under intravenous sedation were enrolled. Patients were randomized to receive either 2 mL (8 mg) dexamethasone sodium phosphate or 2 mL of IV solution (placebo) prior to the first surgery, and 2 mL of the other solution prior to the second surgery. Post-operative discomfort was managed with a standardized regimen of 600 mg ibuprofen and 325 mg acetaminophen. A smart phone application was used to record self-assessed pain and swelling scores using 21-point numerical (NRS-21) and 4-point verbal (VRS-4) rating scales as well as the number of analgesic medications taken at 12-, 24-, 48-, 72-, 168-, and 336-hours following each surgery. RESULTS Intravenous dexamethasone was associated with a significant reduction in pain at 12-, 24-, 48-, and 72-hours (P < 0.05), and swelling at 12-, 24-, 48-, and 168-hours (P < 0.05) postoperatively when compared to placebo based on NRS-21 responses. VRS-4 data showed significant reductions in pain at 12-, 72-, and 168-hours and swelling at 12-, 24-, and 168-hours post-operatively with dexamethasone. No significant differences were found in the number of tablets of ibuprofen or acetaminophen between dexamethasone and placebo surgeries. CONCLUSIONS Preoperative, intravenously administered dexamethasone reduces pain and swelling within the first post-operative week following periodontal flap surgery and should be considered a useful adjunct for peri-operative management. This article is protected by copyright. All rights reserved.