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Abstract
Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58–0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.
Highlights
Scoliosis correction surgery has been described as the most invasive orthopaedic surgery performed in young persons[1]
Multinational survey demonstrated that the use of dexamethasone for postoperative nausea and vomiting (PONV) prophylaxis is common practice in paediatric scoliosis surgery[8], the effect of dexamethasone on PONV prevention has not been validated for highly-invasive surgical procedures that require opioid-based patient-controlled analgesia (PCA) for postoperative analgesia, in which PONV can be prolonged by opioids
The aim of this study was to determine whether dexamethasone reduces PONV in children and adolescents undergoing highly invasive surgery, such as posterior correction and spinal fusion surgery for adolescent idiopathic scoliosis (AIS)
Summary
Scoliosis correction surgery has been described as the most invasive orthopaedic surgery performed in young persons[1] This surgery is associated with severe postoperative pain that requires advanced pain management, which is typically opioid-based patient-controlled analgesia (PCA). The evidence for prophylactic use of dexamethasone in paediatric patients is based only on minor surgical procedures, such as tonsillectomy and strabismus surgery[6,7], in which PONV may be induced by volatile anaesthetics or intraoperative opioids. Multinational survey demonstrated that the use of dexamethasone for PONV prophylaxis is common practice in paediatric scoliosis surgery[8], the effect of dexamethasone on PONV prevention has not been validated for highly-invasive surgical procedures that require opioid-based PCA for postoperative analgesia, in which PONV can be prolonged by opioids. The aim of this study was to determine whether dexamethasone reduces PONV in children and adolescents undergoing highly invasive surgery, such as posterior correction and spinal fusion surgery for adolescent idiopathic scoliosis (AIS)
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