Excruciating perineal pain after intravenous dexamethasone

Abstract

We describe two cases of unexpected perineal pain immediately after intravenous injection of fentanyl and dexamethasone (100 μg and 8 mg respectively) during induction of general anaesthesia. In both cases the pain was immediate (onset within 30 seconds), severe, localized to the genital region and of shooting and burning character. No other clinical signs or symptoms were observed in either case and both patients made an uneventful recovery without neurological sequelae. We review the existing literature on perineal pain as an adverse effect of intravenous corticosteroid esters and recommend their administration either in diluted form or after induction of general anaesthesia.