Is there a role for perioperative use of dexamethasone in facial fracture surgery? : aspects in postoperative nausea and peripheral nerve recovery

Background and purpose: Glucocorticoids (GCs) are used in various medical indications. One generally accepted and well-known indication is perioperative administration to reduce postoperative nausea and vomiting. GCs are also used with mixed results in promoting nerve recovery after an injury. However, these two potential indications have not been extensively investigated in facial trauma populations. The aim of this study was to determine whether dexamethasone could reduce the incidence of postoperative nausea and vomiting (PONV) and promote nerve recovery in the trigeminal nerve area after a facial trauma. Patients and methods: The study was based on a randomized controlled trial where patients were randomized to either receive dexamethasone or serve as a control. Study I included patients with different types of facial fractures (n=119), Study II patients with isolated zygomatic complex (ZC) fractures (n=64), Study III patients with isolated orbital fractures (n=18), and Study IV patients with one or two fractures in the dentate part of the mandible (n=27). In Study I, the outcome variable was PONV and the primary predictor variable was the administration of perioperative dexamethasone. In Studies II-IV, the outcome variable was neurosensory disturbance (NSD) at 6 months and the primary predictor variable was the use of perioperative dexamethasone. Results: The overall PONV incidence (Study I) was 16.8%. Dexamethasone did not reduce PONV incidence. In Studies II-IV, dexamethasone did not reduce long-term NSD. PONV was significantly more common in patients who received postoperative opioids. In Study III, a significant predictor for prolonged NSD was treatment delay. Conclusions: The role of short-term dexamethasone in the indications studied remained insignificant. The findings therefore do not support the use of perioperative dexamethasone in reducing PONV or postoperative NSD in facial fracture patients. The low number of study subjects excluded the possibility for subgroup analysis.