IV Dexamethasone in Burn Injury: Not Recommended
Intravenous dexamethasone should NOT be used in the acute management of burn injuries, as it provides no analgesic benefit, does not reduce inflammatory responses, and lacks evidence for improving outcomes in thermal burns. 1
Evidence Against Dexamethasone Use
Lack of Analgesic Efficacy
- A randomized, double-blind, placebo-controlled trial demonstrated that IV dexamethasone 8 mg administered 2 hours before burn injury failed to reduce pain ratings, tactile allodynia, skin erythema, or hyperalgesia compared to placebo 1
- Dexamethasone showed no effect on thermal or mechanical pain thresholds, and did not reduce inflammatory-mediated changes in quantitative sensory testing 1
No Benefit in Inhalation Injury
- A prospective randomized trial of 60 burn patients with confirmed inhalation injury found that dexamethasone (versus placebo) showed no differences in mortality, pulmonary complications, or pulmonary function changes 2
- This trial specifically evaluated the steroid's role in preventing early pulmonary edema and late Gram-negative pneumonitis, finding no protective effect 2
Limited Evidence in Other Burn Types
- While one animal study suggested dexamethasone may reduce stricture formation in esophageal caustic burns 3, this does not translate to thermal burn management and involves a completely different injury mechanism
- Current burn guidelines make no mention of corticosteroids as part of acute burn management protocols 4
Recommended Acute Burn Management Instead
Fluid Resuscitation
- Administer 20 mL/kg of balanced crystalloid solution (Ringer's Lactate preferred) within the first hour for adults with TBSA ≥20% or children with TBSA ≥10% 4
- Balanced crystalloid solutions are superior to 0.9% NaCl due to lower risk of hyperchloremic acidosis and acute kidney injury 4
Pain Management
- Use titrated IV ketamine combined with short-acting opioids (fentanyl) for severe burn pain, as this reduces morphine consumption while maintaining spontaneous breathing 5
- All analgesics must be titrated using validated comfort and analgesia assessment scales 5
- Multimodal analgesia with acetaminophen and NSAIDs should be considered for systemic pain control 6
Wound Care
- Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 6
- Apply petrolatum-based products or appropriate antibiotic ointments after cooling 6
- Cover with clean, non-adherent dressings 6
Critical Pitfall to Avoid
Do not use dexamethasone or other corticosteroids in acute thermal burn management. The evidence clearly demonstrates no benefit for pain control, inflammation reduction, or outcome improvement, while corticosteroids carry known risks of immunosuppression, infection, and impaired wound healing in burn patients 1, 2. Focus instead on evidence-based interventions: aggressive fluid resuscitation, multimodal analgesia with ketamine and opioids, and appropriate wound care 4, 5, 6.