Intraperitoneal dexamethasone as an adjuvant to local anesthesia in laparoscopic surgery

11 أغسطس 2026
عبدالله الحربي
Intraperitoneal dexamethasone as an adjuvant to local anesthesia in laparoscopic surgery

Background

Dexamethasone is commonly added to local anesthetic–based perioperative regimens to improve postoperative analgesia and reduce postoperative nausea and vomiting (PONV), but the consistency of benefit across procedures remains uncertain.

Methods

We performed a systematic review and meta-analysis of randomized controlled trials comparing dexamethasone-containing regimens versus the same local anesthetic without dexamethasone. PubMed, Web of Science, Scopus, and the Cochrane Library were searched. Outcomes included pain scores at prespecified postoperative timepoints (1–24 h), rescue analgesia use and timing, and PONV. Random-effects models were applied.

Results

Nine trials were included from 902 records. Most were laparoscopic cholecystectomy, with one bariatric-surgery trial and one hysterectomy trial; comparisons were generally balanced (20–52 patients/arm). Pain scores significantly favored dexamethasone addition at 1 h (MD − 0.75), 2 h (MD − 0.84), 4 h (MD − 1.91), 12 h (MD − 1.12), and 24 h (MD − 1.28), but heterogeneity was substantial to high across timepoints (I² ≈72%–96%) and prediction intervals generally crossed the null. Rescue analgesia use within 0–24 h was significantly reduced with the addition of dexamethasone (RR 0.85), and time to first rescue analgesia was longer (MD 169 min). PONV was consistently lower with dexamethasone (RR 0.28) with no heterogeneity observed.

Conclusions

Dexamethasone reduces PONV reliably and may improve postoperative pain, rescue analgesia requirements and PONV, although analgesic effects are inconsistent across trials. Data availability

Data is available on reasonable request.


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Acknowledgements

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Funding

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Author information

Authors and Affiliations

  1. Department of Clinical Research and Scientific Services, Publication Hub, Riyadh, Saudi Arabia
  2. Mohamed Saad Rakab
  3. College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
  4. Basim Alshahrani
  5. College of Medicine, Taibah University, Madinah, Saudi Arabia
  6. Mukhtar Shaybah Alshanqiti
  7. College of Medicine, King Saud University, Riyadh, Saudi Arabia
  8. Abdulillah Mohammed Al Rashoud
  9. College of medicine, Northern Boarders University, Arar, Saudi Arabia
  10. Joori Badi Rasheed Alanazi & Anas Ied Alenezi
  11. College of Medicine, Qassim University, Qassim, Saudi Arabia
  12. Basel Ayed Almutairi & Abdullah Mulfi Alharbi
  13. Royal College of Surgeons in Ireland, Manamah, Bahrain
  14. Mohammad Nahar Alshammiri
  15. Arabian Gulf University, Manamah, Bahrain
  16. Ali Ahmed Alshamrani
  17. College of medicine, Tanta university, Tanta, Egypt
  18. Mohammed Adel Alherz
  19. Consultant Family Medicine and Medical Education, Ministry of Defense Health Services, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
  20. Jaber Aabdullah Alshahrani

Contributions

M.S.R. led the study design, data extraction, statistical synthesis, and drafting of the manuscript. B.A. and M.S.A. contributed to protocol development, literature search, and study selection. A.M.A.R. and J.B.R.A. supported data extraction, verification of extracted outcomes, and preparation of study characteristics tables. B.A.A. and M.N.A. performed risk of bias assessments. A.A.A. and A.I.A. contributed to data validation, figure preparation, and formatting of supplementary materials. M.A.A., J.A.A. and A.M.A. supported methodology refinement, interpretation of findings, and critical revision of the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content, read and approved the final manuscript, and agreed to be accountable for all aspects of the work. All authors have read and agreed to the final version of the manuscript.

Corresponding author

Correspondence to Mohamed Saad Rakab.

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The authors declare no competing interests.

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