Postoperative outcomes of jaw surgery under general anesthesia using a standardized dexamethasone and local anesthesia protocol: a prospective observational study

Postoperative recovery after jaw surgery is often compromised by pain, swelling, and trismus. Although corticosteroids are commonly used, there is a need for clinical protocols that reduce the reliance on prolonged systemic analgesics. This study evaluates the efficacy of a multimodal protocol combining intraoperative local anesthesia with a weight-based single dose of IV Dexamethasone. This prospective clinical study included 60 patients (ASA I-II) undergoing cyst enucleation or impacted tooth extraction under general anesthesia. A standardized protocol of a local anesthetic block (Articaine + Epinephrine) and weight-based IV Dexamethasone (0.1 mg/kg) was administered intraoperatively. Outcomes included VAS scores, facial swelling (Daniel Lim’s method), and trismus on days 1, 2, and 7. Total analgesic consumption during the first 24 h and the subsequent week was recorded. Data were analyzed using SPSS v20.0. Normality was tested via Kolmogorov-Smirnov. Changes over the follow-up period were evaluated using repeated-measures analysis, with p < 0.05 considered statistically significant. The protocol achieved excellent pain control, with mean VAS scores of 2.3 at 30 minutes and 0.8 at 6 hours. Notably, 95% of patients required no rescue analgesia during post-anesthesia care. While 81.7% of patients required oral analgesics at home within the first 24 hours, no further medication was needed thereafter. Facial swelling and trismus were minimal and resolved rapidly, with 78.3% of patients showing no functional restriction by Day 1. In this observational cohort, combining intraoperative local anesthesia with 0.1 mg/kg IV Dexamethasone showed an 'analgesic-sparing' effect. However, the lack of a control group in this single-arm observational study limits definitive conclusions about causality. This protocol not only enhances patient comfort but also notably decreases the need for systemic analgesics during the early postoperative phase. ClinicalTrials.gov NCT06787196. Registered December 27, 2024. Retrospectively registered.