Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature.

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.