A Single Perioperative Injection of Dexamethasone Decreases Nausea, Vomiting, and Pain after Laparoscopic Donor Nephrectomy.

Shigeyoshi Yamanaga,Mehdi Tavakol,Sang-Mo Kang,Chris Earl Freise,Takaaki Kobayashi,Andrew Mark Posselt

doi:10.1155/2017/3518103

Abstract

Background. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Methods. We performed a retrospective cohort study of living donors who underwent LDN between 2013 and 2015. Donors who received a lower dose (4–6 mg) (n = 70) or a higher dose (8–14 mg) of dexamethasone (n = 100) were compared with 111 donors who did not receive dexamethasone (control). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. Results. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P = 0.010) compared to control, but the lower dose did not. Total opioid use was 29% lower in donors who received the higher dose than in control (P = 0.004). The higher dose was identified as an independent factor for preventing postoperative nausea and vomiting. Postoperative complication rates and hospital stays did not differ between the groups. After propensity-score matching, the results were the same as for the unmatched analysis. Conclusion. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications.

Highlights

Laparoscopic donor nephrectomy (LDN) has been proven to be a safe procedure [1,2,3] and is the gold standard for donor nephrectomy
We examined whether different doses of preoperative dexamethasone would be effective in reducing Postoperative nausea and vomiting (PONV) and opioid consumption without increasing postoperative complications after laparoscopic donor nephrectomy (LDN)
42 donors were excluded from the analysis for the following reasons: one had a history of ulcerative colitis, one had two operations because the recipient had intraoperative problems during the first operation, one received hydrocortisone instead of dexamethasone, and 39 had a prior history of PONV, which is a well-established risk factor for PONV [14] and should be excluded from outcome analysis [15]

Summary

Introduction

Laparoscopic donor nephrectomy (LDN) has been proven to be a safe procedure [1,2,3] and is the gold standard for donor nephrectomy. LDN has many advantages compared to open donor nephrectomy, including reduced pain, earlier return to work, and improved cosmetic results [1]. Postoperative nausea and vomiting (PONV) occurs in 50–75% of patients after laparoscopic surgery [4]. In other studies, a higher dose of dexamethasone (≥8 mg or ≥0.1 mg/kg) appeared more effective for PONV than the low dose of 4-5 mg [8, 9]. A single dose of perioperative dexamethasone (8–10 mg) reportedly decreases postoperative nausea, vomiting, and pain but has not been widely used in laparoscopic donor nephrectomy (LDN). Outcomes and incidence of postoperative nausea, vomiting, and pain within 24 h after LDN were compared before and after propensity-score matching. The higher dose of dexamethasone reduced postoperative nausea and vomiting incidences by 28% (P = 0.010) compared to control, but the lower dose did not. A single perioperative injection of 8–14 mg dexamethasone decreases antiemetic and narcotic requirements in the first 24 h, with no increase in surgical complications

Methods

Results

Conclusion