Effect of Intravenous Dexamethasone Added to Intrathecal Morphine on Postoperative Analgesia and Nausea/Vomiting in Geriatric Hip Fractures: A Retrospective Clinical Trial

Background: Hip fractures are associated with high morbidity and mortality in the geriatric population, and adequate postoperative analgesia is crucial for improving outcomes. Intrathecal morphine provides adequate analgesia in geriatric patients with hip fractures, but it can also cause adverse effects such as postoperative nausea and vomiting (PONV) and respiratory depression. Dexamethasone, with its antiemetic and analgesic effects, has the potential to reduce these side effects. This study investigated the effects of intravenous dexamethasone added to intrathecal morphine on postoperative analgesia and PONV. Methods: This retrospective observational study included geriatric patients (≥65 years) who underwent hip fracture surgery under spinal anesthesia using 0.1 mg intrathecal morphine between January 2024 and August 2024. Patients were classified into two groups: those receiving 8 mg of intravenous dexamethasone before the procedure (Group D) and those receiving a placebo (Group P). Postoperative pain scores (VAS: Visual analog scale), opioid (contramal) consumption, PONV, respiratory depression, and pruritus were compared between the groups during the first 24 hours. Results: A total of 80 patients, 40 in Group D and 40 in Group P, were included in the study. Demographic data, comorbidities, anesthesia, and operation times were similar between the groups. Postoperative VAS scores of patients in Group D were significantly lower than those in Group P at the 2nd (1.2± 0.6 vs. 1.5± 0.6, p=0.027), 6th (2.0± 0.7 vs. 3.1± 0.6, p<0.001), 12th (2.7± 0.8 vs. 4.3± 0.7, p<0.001) and 24th hours (3.2± 0.7 vs. 4.8± 0.4, p<0.001). Contramal consumption in the first 24 hours (70±61 mg vs. 135±58 mg, p<0.001) and PONV rate (7.5% vs. 16.3%, p=0.034) were also significantly lower in Group D. There were no significant differences between the groups in terms of respiratory depression and pruritus. Conclusions: Prophylactic administration of dexamethasone before intrathecal morphine in geriatric hip fracture patients reduces postoperative pain scores, opioid consumption, and PONV rates in the first 24 hours. However, it did not affect adverse events such as respiratory depression and pruritus. Trial registration: ClinicalTrials.gov Identifier: NCT07037745