A single preoperative dose of intravenous dexamethasone significantly reduces postoperative pain and rescue analgesic requirements in patients undergoing percutaneous nephrolithotomy without causing clinically significant hyperglycemia, according to a randomised controlled trial.
Percutaneous nephrolithotomy serves as the gold-standard surgical treatment for large and complex renal calculi due to its minimally invasive nature, lower complication rates, and faster postoperative recovery. Despite these advantages, the procedure often causes significant postoperative pain—stemming from visceral pain due to renal capsule dilatation, parenchymal tract expansion, and peritubular compression by the nephrostomy tube, as well as somatic pain from the access site—which can delay mobilisation and hospital discharge.
Trial Design and Methodology
The prospective double-blind randomised placebo-controlled study took place in the Department of Anaesthesiology of a tertiary healthcare institute from April 2025 to December 2025, following institutional ethics committee approval and written informed consent. Investigators registered the trial in the Clinical Trial Registry of India under the identifier CTRI/2025/04/083893, conducting and reporting it in accordance with the ethical standards of the Declaration of Helsinki.
The trial examined 70 American Society of Anesthesiologists (ASA) grade I and II patients, aged 18 to 60 years of either gender, undergoing percutaneous nephrolithotomy under general anaesthesia. Researchers administered either intravenous dexamethasone 8 mg in 2 ml or normal saline 2 ml to patients preoperatively, exactly one hour before surgery. Patient haemodynamic data, baseline blood sugar levels, and Visual Analogue Scale scores were recorded prior to the procedure.
Researchers Track Postoperative Pain Scores and Blood Sugar Levels
Following surgery, investigators tested blood sugar levels before shifting patients to the Post Anaesthesia Care Unit. Once inside the unit, they tracked haemodynamic data, Visual Analogue Scale scores, and the requirement for injection paracetamol at 0, 6, 12, 24, and 48 hours.
A two-way repeated-measures ANOVA with Greenhouse-Geisser correction demonstrated a significant difference in Visual Analogue Scale scores between the Dexamethasone and Normal Saline groups. Ultimately, the trial concluded that preoperative administration of the single intravenous dexamethasone dose significantly cuts down the requirement for postoperative rescue analgesia while showing no significant effect on blood sugar.
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