Abstract
BackgroundDexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV), and recent reviews suggest a role for dexamethasone in postoperative analgesia. The aim of this study is to evaluate the efficacy of dexamethasone as an analgesic adjuvant in minimally invasive thoracic surgery. Primary outcome was morphine consumption 24 h after surgery; secondary outcomes were pain control, measured as numeric rating scale (NRS), glycemic changes, PONV, and surgical wound infection.ResultsWe performed a retrospective cohort study considering 70 patients who underwent elective lobectomy, segmentectomy, or wedge resection surgery with a mini-thoracotomy approach or video-assisted thoracoscopic surgery (VATS). All patients received the same locoregional techniques and short-acting opioids during surgery; 46 patients received dexamethasone at induction. There were no significant differences in morphine consumption at 24 h (p = 0.09) and in postoperative pain scores. Nevertheless, a higher frequency of rescue therapy (p = 0.01) and a tendency for a higher attempted-PCA pushes count were observed in patients who did not receive dexamethasone. No cases of surgical wound infections were detected, and the incidence of PONV was similar in the two groups. Postoperative glycemia was transiently higher in the dexamethasone group (p = 0.004), but the need of hypoglycemic therapy was not significantly different.ConclusionsPreoperative administration of dexamethasone did not cause a significant reduction in morphine consumption, but appears to be safe and plays a role in a multimodal anesthesia approach for patients undergoing elective minimally invasive thoracic surgery.
Highlights
Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV), and recent reviews suggest a role for dexamethasone in postoperative analgesia
A recent review shows that 8 mg of dexamethasone before surgical incision may be beneficial in some surgeries, such as laparoscopic cholecystectomies, thyroidectomies, Umari et al Journal of Anesthesia, Analgesia and Critical Care
Intraoperative morphine bolus was similar for the two groups, when different surgical approaches and interventions were taken into consideration as confounding factors in a multivariate analysis (0.15 mg/kg adjusted body weight (ABW) in the dexamethasone group vs 0.16 mg/kg ABW in the control group, p = 0.31)
Summary
Dexamethasone is commonly used for the prevention of postoperative nausea and vomiting (PONV), and recent reviews suggest a role for dexamethasone in postoperative analgesia. Dexamethasone is a drug commonly used in anesthesia for the prevention of postoperative nausea and vomiting (PONV) [4,5,6,7] and is used as an adjuvant to peripheral nerve block, since it has shown to prolong duration of sensory block with either perineural or intravenous administration [8, 9]. Many studies demonstrated that patients receiving dexamethasone in the perioperative period experienced less pain, requested a minor dosage of opioids in the postoperative period, needed fewer rescue doses, and had a shorter stay in post-anesthesia care units as well [10]. Randomized trials failed to prove a significant alteration of glucose homeostasis either in diabetic or in non-diabetic patients, and a hyperglycemic state after dexamethasone appeared to extend to the first 24 h after surgical operation, blood levels remained in the recommended range during the perioperative period [15]
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