Intraperitoneal dexamethasone as an adjuvant to local anesthesia in laparoscopic surgery: A systematic review and meta-analysis of randomized controlled trials.

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.