BACKGROUND METHODS CONCLUSION A systematic search identified Risk ratios (RR), mean differences (MD), and standardized mean differences (SMD) with 95% confidence intervals (CIs) were pooled using a random effects model. Study quality was evaluated using the Cochrane RoB 2 tool, while the quality of evidence for outcomes was assessed with GRADEpro. Publication bias was assessed through funnel plot analysis. (PROSPERO registration number: CRD42024608067) Figure 2: Forest plot of (A) Pain at 24 hours, (B) Pain at 8 to12 hours, and (C) Pain at 4 hours A B C Figure 1: PRISMA Flow Diagram Hysterectomy, a common surgical procedure, often leads to moderate-to-severe postoperative pain and increased postoperative nausea and vomiting (PONV). Dexamethasone, a corticosteroid, may mitigate these issues; however, existing evidence is largely generalized across surgical populations and does not clearly define its efficacy and safety in patients undergoing hysterectomy. This meta analysis provides a focused, updated synthesis of randomized controlled trials in hysterectomy, with time-stratified pain outcomes and subgroup analysis of dosing and administration timing, to evaluate dexamethasone’s role in postoperative recovery. RESULTS Fifteen RCTs (1,362 patients) were included. Dexamethasone significantly reduced PONV (RR: 0.53, 95% CI 0.47–0.61, p < 0.00001, I : 0% high certainty) and pain scores at 24 hours (MD: -0.20, 95% CI -0.35 to -0.05, p = 0.009, I² = 0%, moderatecertainty), 8 to 12 hours (MD: -0.60, 95% CI -0.88 to -0.31, p < 0.0001, I: 27%, moderate certainty and 4 hours.(MD: -0.43, 95% CI -1.07 to 0.21, p = 0.19, 93%, moderate certainty). It also decreased the use of rescue antiemetics (RR: 0.57, 95% CI 0.43–0.75, I: 39%, high certainty) and postoperative opioid consumption (SMD: -0.48, 95% CI -0.90 to -0.05, p= 0.03, I 74%, low certainty). The effects on rescue analgesics and hospital stay duration were nonsignificant. Subgroup analyses showed consistent antiemetic efficacy of dexamethasone across doses, timings, routes, and procedures. For pain, greater analgesic effects were seen with higher doses and perineural administration, particularly at 8–12 hours. Risk of bias was low in most studies and evidence of publication bias observed for pain score outcome. 2 2 2 2 Bansal T, Singhal S, Taxak S, Bajwa SJS. Dexamethasone in anesthesia practice: A narrative review. J Anaesthesiol Clin Pharmacol. 2024 Jan-Mar;40(1):3-8. doi: 10.4103/joacp.joacp_164_22. Epub 2024 Mar 14. PMID: 38666172; PMCID: PMC11042091. Andersen R, Krohg K. Pain as a major cause of postoperative nausea. Can Anaesth Soc J. 1976 Jul;23(4):366-9. doi: 10.1007/BF03005916. PMID: 7347. Xu L, Xie X, Gu X. Dexamethasone for preventing postoperative nausea and vomiting after mastectomy. Medicine (Baltimore). 2020 Jul 24;99(30):e21417. doi: 10.1097/MD.0000000000021417. PMID: 32791759; PMCID: PMC7387045. Hirayama T, Ishii F, Yago K, OGATA H. Evaluation of the effective drugs for the prevention of nausea and vomiting induced by morphine used for postoperative pain: a quantitative systematic review. Yakugaku Zasshi 2001;121:179–85. REFERENCES Efficacy & Safety of Dexamethasone in Postoperative Recovery Following Hysterectomy: A Systematic Review and Meta-analysis Kiran Inam, MD, Muhammad Saeed Qazi, MBBS, Eeshal Fatima, MBBS, Maryam Arfa Khan, MBBS, Ahmad Hassan, MBBS, Iftikhar Khan, MBBS, Imama Yaseen, MBBS, Syeda Bakhtawar Ali, MBBS, Anam Ghafoor Azeemi, MBBS ,Husnain Ahmad,MBBS a b c d e f g h i d 1 Department of Anesthesiology, Peshawar Institute of Cardiology, Peshawar, Pakistan, Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan, Shalamar Medical and Dental College, Lahore, Pakistan, Aga khan University Hospital, Karachi,Pakistan, FMH College of Medicine and Dentistry Lahore, Pakistan, Rashid Latif Medical College, Lahore, Pakistan, Rehman Medical College, Peshawar, Pakistan, Department of Obstetrics & Gynecology, Lady Reading Hospital, Peshawar Pakistan a b c d e f g h i Your paragraph text Dexamethasone is an effective adjunct in hysterectomy, significantly reducing PONV and postoperative pain at 8–12 and 24 hours, particularly with 4–10 mg doses. Benefits are consistent across routes, timings, and surgical approaches, with greater early analgesia after perineural use. It reduces opioid consumption but has a limited effect on rescue analgesia, supporting its role as a complementary analgesic. While generally considered safe, current safety data are limited, highlighting the need for further research. These results support its use in multimodal recovery protocols and identify priorities for future studies in high-risk and diverse surgical populations.