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Correspondence

Intravenous bolus injection of dexamethasone and transient excruciating perineal pain

Ajmal, Muhammad; Carey, Michael

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European Journal of Anaesthesiology: January 2015 - Volume 32 - Issue 1 - p 67-68
doi: 10.1097/EJA.0000000000000180
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Editor,

We read the article by Soltesz et al.1 in the August 2014 issue of the Journal and found it interesting that dexamethasone, a drug very commonly used in current perioperative or anaesthesia practices, antagonises rocuronium-induced neuromuscular blocks. We would like to draw your attention to an unpleasant adverse effect of dexamethasone that has been described in association with intravenous bolus injections in awake patients.2

Dexamethasone, a synthetic glucocorticoid, is commonly used as a single-dose treatment to prevent postoperative nausea or vomiting. It does not seem to cause any significant long or short-term adverse effects.3 However, it is our common observation that an intravenous bolus injection of dexamethasone in awake patients may give rise to the unusual adverse effect of transient excruciating perineal itch and pain. Therefore, we always administer this drug after having anaesthetised the patient with general or spinal anaesthesia. This adverse effect has been reported by many other investigators.4–7 Singh et al.7 determined that the incidence of dexamethasone induced perineal pain was higher in women than in men (56 vs. 30%), and the mean duration of this pain was also longer in women than in men (29 vs. 23 s). Dexamethasone is available as a sterile solution of dexamethasone sodium phosphate containing methylparaben and propylparaben as preservatives. Although the exact mechanism of dexamethasone induced perineal pain is unknown, phosphate esters have been postulated to be responsible. Diluting the drug in 50 ml of solution and administering it over 5 to 10 min can mitigate this adverse effect.7

Soltesz et al.1 administered 8 mg of dexamethasone intravenously to at least 72 awake women (group A plus group B). We are curious to know how they administered the drug and whether any such adverse effects were encountered.

Acknowledgements relating to this article

Assistance with the letter: none.

Financial support and sponsorship: none.

Conflicts of interest: none.

References

1. Soltesz S, Fraisl P, Noe KG, et al. Dexamethasone decreases the duration of rocuronium-induced neuromuscular block. Eur J Anaesthesiol 2014; 31:417–422.
2. Perron G, Dolbec P, Germain J, Béchard P. Perineal prurities after i.v. dexamethasone administration. Can J Anaesth 2003; 50:749–750.
3. Colin B, Gan TJ. Cancer recurrence and hyperglycemia with dexamethasone for postoperative nausea and vomiting prophylaxis: more moot points. Anesth Analg 2014; 118:1154–1156.
4. Neff SP, Stapelberg E, Warmington A. Excruiating perineal pain after intravenous dexamethasone. Anaesth Intensive Care 2002; 30:3701.
5. Klygis LM. Dexamethasone –induced perineal irritation in head injury. Am J Emerg Med 1992; 10:268.
6. Thomas VL. More on dexamethasone –induced perineal irritation. N Engl J Med 1986; 314:1643–1644.
7. Singh M, Sharma CS, Rautela RS, Taneja A. Intravenous dexamethasone causes perineal pain and pruritus. J Anesth Clinic Res 2011; S1:001–003.
© 2015 European Society of Anaesthesiology