Effects of naloxone on post-operative pain and steroid-induced analgesia.

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Abstract
1 In a controlled crossover study identical oral surgical procedures were performed on two separate occasions in six patients. 2 Two h after surgery, either 40 mg methylprednisolone (Solu‐Medrol) or placebo (saline) was administered intravenously in a double‐blind randomized fashion. 3 Five h after surgery, three patients received 4 mg naloxone (Nalonee) while 3. Five h after surgery, three patients received 4 mg naloxone (Nalonee) while three patients received placebo (saline) intravenously, followed by a crossover to alternative injections 1 h thereafter. 4 Several measurements/assessments were recorded for a paired comparison of the post‐operative courses. 5 The mean pain assessment (VAS) was reduced by about 50% 45 min after the steroid injection (P = 0.03). 6 Neither increasement of the post‐operative pain nor reversal of the steroid‐induced analgesia could be demonstrated by injection of 4 mg naloxone. 7 Swelling was reduced by 46% on day 3 after the operation when the steroid was injected as compared to placebo (P = 0.06); on day 6 the reduction averaged 60% (P = 0.04). 8 According to overall assessments after the second operation all patients expressed clear preference for the post‐operative course when the steroid was injected. 9 Present and previous results in this model with bilateral oral surgery suggest that short term corticosteroid administration deserves attention as an efficient means which may be of value in reducing pain and excessive inflammation in surgery and traumatology.