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Canadian Journal of Anesthesia 50:749-750 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

Perineal pruritus after iv dexamethasone administration

Gino Perron, MD FRCPC, Pierre Dolbec, MD FRCPC, Julie Germain, MD FRCPC and Philippe Béchard, MD MSc FRCPC

Lévis, Québec

To the Editor:

Intravenous dexamethasone is useful in the prevention or treatment of postoperative nausea and vomiting. We recently observed an unusual reaction after the administration of iv dexamethasone in three consecutive patients before induction of general anesthesia. Immediately after receiving a bolus injection of 8 mg of dexamethasone sodium phosphate (Sabex, Boucherville, QC, Canada), the patients experienced perineal burning, itching and tingling. This reaction was short-lived with a duration ranging from 30 to 45 sec. After informed consent was obtained, 20 additional patients (10 males and 10 females) were asked about the occurrence of an unusual sensation after a bolus administration of dexamethasone before induction of general anesthesia (TableGo). All females reported the same reaction, while only three males were affected.


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  		TABLE Perineal pruritus after iv dexamethasone administration
 
Intravenous dexamethasone-induced perineal pruritus has been described in association with antiemetic use in chemotherapy,1 in the setting of acute head injury secondary to blunt trauma in an attempt to reduce intracranial pressure,2 and as an anti-inflammatory agent in the perioperative course of oral surgery.3 We are not aware of any similar reports in the anesthetic literature. The incidence of this reaction has not been clearly defined but could range between 25 to 100% depending on the dose and speed of administration.1–5 We observed that females seem more at risk of presenting this adverse effect, a finding that has been already described in the literature.3,4 The pharmacological mechanism explaining this phenomenon remains poorly understood, but could be related to the phosphate ester of the corticosteroid since perineal irritation has been described with hydrocortisone-21-phosphate sodium and prednisolone phosphate.1 Fortunately, this adverse effect can be diminished or even abolished by giving dexamethasone diluted in 50 mL of fluid over five to ten minutes.1,3,5

In conclusion, anesthesiologists should be aware of this unusual adverse reaction. The slow iv infusion of diluted dexamethasone seems to prevent perineal irritation and patient discomfort.

References

1 Thomas VL. More on dexamethasone-induced perineal irritation (Letter). N Engl J Med 1986; 314: 1643–4.[Medline]

2 Klygis LM. Dexamethasone-induced perineal irritation in head injury (Letter). Am J Emerg Med 1992; 10: 268.[Medline]

3 Andrews D, Grunau VJ. An uncommon adverse effect following bolus administration of intravenous dexamethasone. J Can Dent Assoc 1986; 52: 309–11.

4 Taleb N, Geahchan N, Ghosn M, Brihi E, Sacre P. Vulvar pruritus after high-dose dexamethasone (Letter). Eur J Cancer Clin Oncol 1988; 24: 495.[Medline]

5 Czerwinski AW, Czerwinski AB, Whitsett TL, Clark ML. Effects of a single, large, intravenous injection of dexamethasone. Clin Pharmacol Ther 1972; 13: 638–42.[Medline]




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