Dexamethasone Induced Perineal Pruritus in Patients Undergoing Minor Oral Surgical Procedures- A Prospective Cohort Study

Introduction: Dexamethasone is frequently used by oral and maxillofacial surgeons to control postoperative oedema and pain in minor oral surgery procedures. Intravenous administration of dexamethasone may result in perineal pruritus i.e., perineal itching, pain and burning sensation. Different studies previously have reported these symptoms in patients. The incidence of these symptoms can vary between 25-100% depending on the dose of dexamethasone administered.

Aim: To evaluate the relationship between intravenous administration of dexamethasone and perineal pruritus in patients requiring minor oral surgical procedures; and its association with the phase of the menstrual cycle in female patients.

Materials and Methods: A prospective cohort study was conducted in the Department of Dentistry, Apollo Hospitals, Secunderabad, Telangana, India, which included 81 patients (43 females and 38 males) between October 2020 to March 2021. All patients included in the study were given preoperative 2 mL (8 mg) of intravenous dexamethasone, 30 minutes before commencing the minor oral surgical procedures and patients were enquired about symptoms of perineal pruritus. Female patients were asked about the phase of the menstrual cycle. All observations recorded were analysed using the Chi-square test and Spearman’s analysis. Statistical Package for the Social Sciences (SPSS) version 26.0 software was used for statistical analysis and p-value <0.05 was considered statistically significant.

Results: A total of 81 patients (aged 19-52 years) were assessed, with the mean age of male patients being 29.3 years, and the mean age of female patients being 28.7 years. Most patients (female 82% and male 35%) experienced symptoms of itching and burning sensation for 60-90 seconds, which subsided without any further treatment. Female patients out numbered the male patients in experiencing the symptoms of perineal pruritus significantly (p-value <0.001). Correlation coefficient was 0.234 (p-value=0.037) which showed a weakly but positive correlation which was statistically significant between the phase of the menstrual cycle and symptoms experienced.

Conclusion: The study established a relation between the administration of i.v. dexamethasone and perineal pruritus. The symptoms were found to be more evident in females and the intensity of the symptoms varied with phases of the menstrual cycle. Females in the postovulatory phase and postmenopausal phase had experienced it more than others. Hence, the knowledge of such incidence and prior education of the patient would reduce the unpleasant experience.