Safety and efficacy of single-dose preoperative intravenous dexamethasone on post-operative nausea and vomiting following breast surgery at Korle-Bu Teaching Hospital.

Papa K G Degraft-Johnson,Ebenezer O Darkwa,Henry K Baddoo,Raymond Essuman,George Aryee,Pokua Sarpong,Robert Djagbletey,Ernest Aniteye

doi:10.4314/gmj.v54i4.2

Papa K G Degraft-Johnson, Ebenezer O Darkwa + Show 6 more

Open Access

https://doi.org/10.4314/gmj.v54i4.2

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Abstract

Dexamethasone has beneficial effects on postoperative nausea and vomiting, however, many clinicians have raised legitimate concerns regarding its effect on blood glucose concentrations. This study determined the safety and efficacy of a single pre-operative dose of dexamethasone for PONV prophylaxis in patients undergoing breast surgery. Prospective, double-blind, placebo-controlled trial. Surgical wards of the Korle-Bu Teaching Hospital, Accra, Ghana. The study was conducted among breast surgery patients. They were consecutively recruited and randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). Patients in the dexamethasone group received 8mg (2mls of 4mg/ml) dexamethasone while those in the placebo group received 2mls of saline intravenously. PONV impact scores and blood glucose levels were recorded at 4, 8 and 24 hours postoperatively. Incidence of PONV and blood glucose levels. The incidence of postoperative nausea (PON) was lower in the dexamethasone group compared with the placebo group (12.8% vs. 29.8%; p-value= 0.044). There was no significant difference in the incidence of postoperative vomiting (POV) and PONV between the two groups. Blood glucose levels were higher in the dexamethasone group throughout the study period and significant at 8 and 24 hours postoperatively (p < 0.05). There was no difference in the incidence of clinically significant hyperglycemia between the groups (p-value = 0.169). A preoperative intravenous dexamethasone 8mg, reduces PON but not POV or PONV in breast surgery without clinically significant postoperative hyperglycemia. Non declared.

Highlights

Breast surgery ranges from minor procedures such as lumpectomies to major and complex procedures such as mastectomy with breast reconstruction
Common postoperative morbidity associated with breast surgery includes postoperative pain, postoperative nausea and vomiting (PONV), seroma formation and chronic pain syndromes.[1]
The incidence of PONV following breast surgery is reported between 34% and 65%

Summary

Introduction

Breast surgery ranges from minor procedures such as lumpectomies to major and complex procedures such as mastectomy with breast reconstruction. The commonest female malignancy, is often the main reason for breast surgery at the Korle-Bu Teaching Hospital. Common postoperative morbidity associated with breast surgery includes postoperative pain, postoperative nausea and vomiting (PONV), seroma formation and chronic pain syndromes.[1]. The incidence of PONV following breast surgery is reported between 34% and 65%.2. Women undergoing mastectomy and axillary clearance have a higher risk of developing PONV, with a reported incidence of 60%80% if prophylactic anti-emetics are not administered.[3,4] Dexamethasone is the traditional drug of choice for the prophylaxis of postoperative nausea and vomiting due to its efficacy.[3,5,6,7] The efficacy of dexamethasone in preventing nausea and vomiting has been shown to be at par with other anti-emetics like droperidol and ondansetron.[8,9] Apfel et al.[9], in their study, reported a 26% reduction in PONV among dexamethasone treated patients. Despite the beneficial effects of dexamethasone, many clinicians have raised legitimate concerns regarding the effect of dexamethasone on blood glucose concentrations and on the incidence of wound infections.10-

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