Preoperative Dexamethasone Research Articles

Transient Hiccups Associated with Oral Dexamethasone

Hiccups, or singulata (hiccup is singultus), are commonly experienced by most people at one time or another and are usually brief and self-limiting. Although pharmacotherapeutic agents are not generally considered causal in the etiology of hiccups, many clinicians empirically associate episodic hiccups in their patients as being drug induced. The two classes of drugs most often cited as causing hiccups are corticosteroids and benzodiazepines. This report involved a patient who was given preoperative dexamethasone and developed hiccups before anesthesia and surgery commenced. He at no time was in distress, and the surgical procedure was completed without complication. By the second postsurgical day his hiccups were resolved completely. Although the association may be anecdotal, many clinicians consider hiccups a potential side effect of steroid therapy, especially high doses of steroids. Of interest in this case is the relatively low dose of corticosteroid used, albeit apparently linked to his hiccups. Practitioners should be aware of this potential condition.

Efficacy of dexamethasone in the prophylaxis of nausea and vomiting during the postoperative period of laparoscopic cholecystectomy

ObjectiveTo verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy. MethodsThis was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included. ResultsThe results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT] = 7), vomiting (NNT = 7), and need for smaller doses of rescue antiemetics (NNT = 6). ConclusionThe preoperative infusion of 8mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy.

THE EFFECT OF DEXAMETHASONE ON POST LAPAROSCOPIC CHOLECYSTECTOMY NAUSEA AND VOMITING

Nausea and vomiting are of the main symptoms affecting patients following laparoscopic procedures with rates ranging between 5-45% in ambulatory surgery cases, they may lead to adverse effects including patients’ demoralization, increased pain level and prolonged hospital stay and so increasing costs of health services. This study determines the effects of preoperative dexamethasone on post laparoscopic cholecystectomy nausea and vomiting. One hundred patients, admitted for laparoscopic cholecystectomy, were divided into two groups. One given dexamethasone intraoperatively, the other received no drug. Both groups received similar anesthetic, surgical and postoperative drug management. The patients were followed in the first twenty-four hours for the development of nausea and vomiting. Nausea and vomiting were significantly reduced in the group receiving dexamethasone on the day of operation with statistical significance. So dexamethasone (8 mg) is recommended to be routinely given at the time of induction of laparoscopic cholecystectomy, since it reduces nausea and frequency of vomiting post laparoscopic cholecystectomy.

Corticosteroid Suppression of Vascular Endothelial Growth Factor and Recurrence of Chronic Subdural Hematoma

We read with interest the article by Berghauser et al1 in which the authors described that in surgical treatment of chronic subdural hematoma (CSDH) with burr hole craniostomy, a longer period of preoperative dexamethasone administration is associated with a lower recurrence rate of CSDH and that dexamethasone administration seems to be unrelated to the higher incidence of complications and treatment-related deaths compared with the current literature. However, the authors mentioned that the mechanism of action of dexamethasone in CSDH has not been fully clarified. We wish to provide further comments on the issue of the effect of preoperative dexamethasone administration on CSDH recurrence. The involvement of vascular endothelial growth factor (VEGF), a potent inducer of angiogenesis and vascular permeability, in the pathogenesis of CSDH and the mechanism of recurrent CSDH has been reported.2-4 Weigel et al2 reported that 5% (4 of 81) of the patients with angiotensin-converting enzyme (ACE) inhibition experienced recurrence as opposed to 18% (42 of 229) of patients without ACE inhibition (P = .00345) and that VEGF content was significantly lower in the hematomas of patients with ACE inhibition than in those without. Greenberger et al5 reported that systemic treatment with dexamethasone led to dose-dependent inhibition of vasculogenesis in an in vivo model of infantile hemangioma and that dexamethasone suppressed VEGF production in hemangioma-derived stem cells in vitro. On the basis of these reports, we consider that the effect of preoperative dexamethasone administration on the recurrence of CSDH might be dependent on the corticosteroid suppression of VEGF. Additionally, Funai et al3 recently reported that phosphatidylinositol 3-kinase/Akt signaling is activated in CSDH outer membranes and that the phosphatidylinositol 3-kinase/Akt pathway might be activated by VEGF in outer membranes. A previous study by Nanko et al4 also revealed that VEGF expression in the outer membrane of 30 patients with CSDH was significantly correlated with VEGF concentration in the hematoma (r[s] = .654, P = .0013) and that VEGF concentration in layered hematomas, which have an intrahematoma membranous structure, was significantly higher than in nonlayered hematomas (P < .01), suggesting that the high concentration of VEGF in the hematoma can originate from the hematoma membrane. We previously reported recurrence rates in 64 consecutive patients after CSDH evacuation.6 Recurrence was noted in 7 of the 64 patients (10.9%) after burr-hole craniostomy with drainage, and layered hematoma was seen in 3 of the 7 recurrent cases (42.9%). Therefore, we consider that preoperative dexamethasone administration might be effective in the prevention of recurrent CSDH, especially in the case of layered-type CSDH. Further investigations on the relationship between preoperative dexamethasone administration and VEGF concentration in the hematoma and the correlation of preoperative dexamethasone administration and preoperative radiological findings of hematomas with CSDH recurrence will provide additional insights into the recurrence of CSDH after preoperative dexamethasone administration. Disclosure The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.

STAT3 Regulates Monocyte TNF-Alpha Production in Systemic Inflammation Caused by Cardiac Surgery with Cardiopulmonary Bypass

BackgroundCardiopulmonary bypass (CPB) surgery initiates a controlled systemic inflammatory response characterized by a cytokine storm, monocytosis and transient monocyte activation. However, the responsiveness of monocytes to Toll-like receptor (TLR)-mediated activation decreases throughout the postoperative course. The purpose of this study was to identify the major signaling pathway involved in plasma-mediated inhibition of LPS-induced tumor necrosis factor (TNF)-α production by monocytes.Methodology/Principal FindingsPediatric patients that underwent CPB-assisted surgical correction of simple congenital heart defects were enrolled (n = 38). Peripheral blood mononuclear cells (PBMC) and plasma samples were isolated at consecutive time points. Patient plasma samples were added back to monocytes obtained pre-operatively for ex vivo LPS stimulations and TNF-α and IL-6 production was measured by flow cytometry. LPS-induced p38 mitogen-activated protein kinase (MAPK) and nuclear factor (NF)-κB activation by patient plasma was assessed by Western blotting. A cell-permeable peptide inhibitor was used to block STAT3 signaling. We found that plasma samples obtained 4 h after surgery, regardless of pre-operative dexamethasone treatment, potently inhibited LPS-induced TNF-α but not IL-6 synthesis by monocytes. This was not associated with attenuation of p38 MAPK activation or IκB-α degradation. However, abrogation of the IL-10/STAT3 pathway restored LPS-induced TNF-α production in the presence of suppressive patient plasma.Conclusions/SignificanceOur findings suggest that STAT3 signaling plays a crucial role in the downregulation of TNF-α synthesis by human monocytes in the course of systemic inflammation in vivo. Thus, STAT3 might be a potential molecular target for pharmacological intervention in clinical syndromes characterized by systemic inflammation.

Dose Ranging Study on the Effect of Preoperative Dexamethasone on Postoperative Quality of Recovery and Opioid Consumption After Ambulatory Gynaecological Surgery

De Oliviera, G.S. Jr; Ahmad, S.; Fitzgerald, P.C.; Marcus, R.J.; Panjwani, A.S.; McCarthy, R.J. Author Information

Clinical Factors Associated With Outcome in Chronic Subdural Hematoma

Chronic subdural hematoma (CSDH) is commonly seen in neurosurgical practice, and the incidence is increasing. Treatment results are highly variable with respect to recurrences and complications. To report our single-center experience with the surgical treatment of CSDH in patients on preoperative corticosteroids and to assess possible predictors of outcome. The medical reports of 496 consecutive patients with CSDHs treated with burr hole craniostomy were analyzed retrospectively. Patient demographics, medication, hematoma, treatment characteristics, and laboratory values were scored in relation to outcome. Data were analyzed with the χ(2) test, independent t test, and multivariate backward regression. Mean age was 71.5 ± 13.3 years (range, 18.6-95.4 years); the male-to-female ratio was 3:1. A decreased Glasgow Coma Scale (GCS) was observed in 63.1%, and GCS motor score on admission was < 6 in 25.2%. Recurrence and mortality rates were 11.9% and 5.3%, respectively. Multivariate analysis showed a longer period of preoperative dexamethasone administration (odds ratio [OR], 0.93 per day; P = .02), GCS motor score within 1 week after surgery of 6 (OR, 0.54; P = .02), postoperative complications (OR, 5.3; P < .001), and a left-sided hematoma (OR, 0.42; P = 0.010) to be significantly related to recurrence risk. The present data suggest that in surgical treatment of CSDH with burr hole craniostomy, extended preoperative corticosteroid administration is associated with a lower recurrence rate. The use of corticosteroids does not seem to be related to a higher incidence of complications and treatment-related death compared with the current literature.

Preoperative Dexamethasone Enhances Quality of Recovery After Laparoscopic Cholecystectomy

Murphy, Glenn S.*; Szokol, Joseph W.*; Greenberg, Steven B.*; Avram, Michael J.†; Vender, Jeffery S.*; Nisman, Margarita*; Vaughn, Jessica* Author Information

Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery

Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery. This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg(-1) or dexamethasone 0.1 mg kg(-1) before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated. Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg(-1) 193 (192-195) was greater than dexamethasone 0.05 mg kg(-1) 179 (175-185) (P=0.004) or saline, 171 (160-182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (0-6.3) mg after dexamethasone 0.1 mg kg(-1) compared with 5.3 (2.4-8.8) mg and 5.3 (2.7-7.8) mg after dexamethasone 0.05 mg kg(-1) and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg(-1) compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg(-1) had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg(-1) and saline. Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg(-1) reduced opioid consumption compared with dexamethasone 0.05 mg kg(-1), which may be beneficial for improving recovery after ambulatory gynaecological surgery.

Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P < 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P < 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P < 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

BackgroundDexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.MethodsIn this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.ResultsDemographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality.ConclusionsPreoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.Trial registration numberNCT01116713

POSTOPERATIVE NAUSEA AND VOMITING (PONV)

Objective: To evaluate the effect of preoperative single dose injection dexamethasone for prevention of PONV in patients undergoing laparoscopic cholecystectomy and comparing it with normal saline (placebo). Design: Experimental RCT study. Place and duration of study: The study was conducted at Madina Teaching hospital, University Medical &amp; Dental College, Faisalabad from January, 2008 to October 2009. Materials and Methods: After approval from the hospital ethical committee, 200 patients with ASA I &amp; II were included in the study. We divided the patients into two groups; group I received preoperative dexamethasone (8mg) and the group II received normal saline (placebo) 90 minutes before the surgery. Patients were observed for any episodes of nausea or vomiting, need for rescue antiemetics, and complete responses in the postoperative period. The complete response was defined as no nausea, no vomiting, and no ant emetic medicationduring a 24-h postoperative period. This was also the primary efficacy end point of the study. The data was analyzed using Pearson’s Chi square test with P &lt; 0.05 taken as significant. Results: Nineteen patients (19%) in the dexamethasone group reported nausea, compared with 43 (43%) in placebo group (p&lt;0.05). Eight patients (8%) in the dexamethasone group reported vomiting and twenty two patients (22%) in theplacebo group reported vomiting (P &lt;0.05). In group I, thirteen patients (13%) asked for rescue anti-emetic where as in group II (placebo group) thirty six patients (36%) asked for rescue anti-emetic (p&lt;0.05). Seventy three patients (73%) in the dexamethasone group showed a complete response, compared with 35 (35%) in placebo group (p&lt;0.05). Conclusion: We concluded that preoperative dexamethasone (8mg) reducesthe incidence of PONV as compared to placebo. As it is a cheap, freely available drug causing no complications, it should be used in otherwise fit selected patients undergoing laparoscopic cholecystctomy.

Effect of dexamethasone on atrial fibrillation after cardiac surgery: a meta-analysis

To assess the effect of preoperative dexamethasone on the occurrence of postoperative atrial fibrillation. Random controlled trails were gathered though searches of PubMed (1966 - 2009.11), EMBASE (1974 - 2009.11), Cochrane Library (issue 4, 2009), Chinese Biomedical Literature Database (1978 - 2009.11), China Journal Full-text Database (1994 - 2009.11), Chinese Scientific Journals Full-text Database (1989 - 2009.11). Two reviewers independently assessed eligibility and quality of trials, then extracted data. Data were synthesized using RevMan5.0 software provided by the Cochrane Collaboration. A total of four randomized controlled trials (667 participants) were included for systematic review. Meta-analysis showed that there were statistical differences between dexamethasone and placebo in postoperative atrial fibrillation (RR = 0.6, 95%CI: 0.40 to 0.92, P = 0.02), dexamethasone did not reduce post-operative mortality (RR = 0.79, 95%CI: 0.28 to 2.22, P = 0.66). The current evidence shows that dexamethasone could reduce the incidence of atrial fibrillation after cardiac surgery, not decrease mortality. There were few limitations in our study may lead to weaken reliability of the conclusions, such as small simple size, different operation types, or the dosage, time and frequency of dexamethasone were unclear. Its effectiveness was needed to further validate in future clinical studies.

How does dexamethasone influence surgical outcome after laparoscopic Nissen fundoplication? A randomized double-blind placebo-controlled trial

Laparoscopic floppy Nissen fundoplication (LFNF) is an effective treatment for gastroesophageal reflux disease. The duration of convalescence, after noncomplicated LFNF, may depend on several factors of which pain, fatigue and sociocultural factors are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. We therefore undertook the present study to investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing uncomplicated laparoscopic floppy Nissen fundoplication. From March 2005 to April 2008, 82 patients were randomized to receive dexamethasone (8mg) intravenously, 90min before skin incision or saline (placebo). Patients received a similar standardized anesthetic, surgical and multimodal analgesic treatment. The primary end points were pain and fatigue. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein (CRP), interleukin-6 and 1 (IL-6, IL-1), pain scores and nausea, and the number of vomiting episodes were registered. Dexamethasone significantly reduced postoperative levels of CRP (p=0.01), IL-6 and IL-1 (p<0.05), fatigue (p=0.01) and overall pain during the first 24 postoperative hours (p<0.05) and the total requirement of analgesic (ketorolac) (p<0.05). Dexamethasone also reduced nausea and vomiting on the day of operation (p<0.05). Preoperative dexamethasone (8mg) reduced pain, fatigue, nausea and vomiting in patients undergoing uncomplicated LNF when compared with placebo.

Effect of Dexamethasone on Postoperative Symptoms in Patients Undergoing Elective Laparoscopic Cholecystectomy: Randomized Clinical Trial

Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effects on other surgical outcomes, such as pain and fatigue, have been unclear. We evaluated the efficacy of preoperative dexamethasone for ameliorating postoperative symptoms after LC. In this prospective, double-blind, placebo-controlled study, 210 patients scheduled for elective LC were analyzed after randomization to intravenous dexamethasone (8 mg) or a placebo. All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and the pain and fatigue scores were recorded on a visual analog scale. Analgesic and antiemetic requirements were also recorded. There were no significant differences between groups with regard to medical or demographic variables. Significantly fewer patients experienced PONV in the dexamethasone group immediately after LC and at 6 and 12 h. The need for ondansetron to relieve PONV was higher in the placebo group (P = 0.001). Patients in the study group reported less postoperative pain during the first 24 h and less fatigue after 6, 12, and 24 h. The need for buprenorphine to relieve intolerable pain was also less in this group (P = 0.009). There were no side effects, and the morbidity was similar in the two groups (6.7 vs. 7.6%). The regimen we employed is safe and without apparent side effects. Thus, preoperative dexamethasone can significantly reduce the incidence of PONV, pain and fatigue after elective LC.

Does Single-dose Preoperative Dexamethasone Minimize Stress Response and Improve Recovery After Laparoscopic Cholecystectomy?

Stress response after laparoscopic cholecystectomy (LC) is less compared with open cholecystectomy, but is still responsible for significant postoperative morbidity. Though preoperative glucocorticoids were found to be effective in reducing the response in open surgical procedures, their role in minimal access surgery is not clear. To evaluate the efficacy of single-dose preoperative dexamethasone in reducing the stress response and postoperative morbidity after LC. In a prospective randomized, double-blind, placebo-controlled trial, 70 patients undergoing elective LC were randomized to receive either dexamethasone (8 mg intravenously), or placebo. The change in C-reactive protein levels after LC, pain scores at rest, and on exertion and narcotic requirements, the incidence and severity of postoperative nausea and vomiting (PONV), anti-emetic requirement, peak expiratory flow rate in both groups were compared. Dexamethasone was more effective in controlling late PONV (P=0.05). The antiemetic requirement was significantly less in the dexamethasone group (0.56 mg vs. 2.24 mg; P=0.02). Median pain scores were significantly less in the dexamethasone group at 24 hours at rest (P=0.002) and on exertion at 24 and 48 hours (P=0.03 and 0.001). Analgesic requirement was less in the test group (22.9 mg vs. 29.9 mg; P=0.054). The peak expiratory flow rate at 48 hours was higher in the dexamethasone group (315.28 vs. 285.8 l/min; P=0.04). The dexamethasone group showed significantly less elevation of C-reactive protein levels at 24 hours (7.17 microg/mL vs. 17.53 microg/mL; P=0.003) and 48 hours (10.65 microg/mL vs. 23.18 microg/mL; P=0.02) postoperatively. Preoperative single-dose dexamethasone significantly reduces the pain scores, PONV, and antiemetic requirements while improving the respiratory function in the postoperative period after LC.

CR04 *DOUBLE BLIND RANDOMISED CONTROLLED TRIAL OF THE INFLUENCE OF GLUCOCORTICOIDS ON POST‐OPERATIVE RECOVERY FOLLOWING COLECTOMY

Introduction: Post‐operative fatigue (POF) is an important indicator of recovery after major surgery. Recent data have suggested a relationship between the post‐operative peritoneal cytokine response and development of POF. Glucocorticoids decrease the production of cytokines and thus we hypothesised that administration of dexamethasone to patients undergoing colonic surgery may decrease peritoneal cytokine production and POF.Aim: To assess the influence of 8 mg of pre‐op IV Dexamethasone on peritoneal cytokine and POF in patients undergoing elective colonic surgery. Method: In a double blinded RCT, 70 consecutive patients undergoing elective, open colonic resection were administered 8 mg I.V. Dexamethasone or saline (Placebo) prior to surgery. All patients were treated within a structured Enhanced Recovery After Surgery program.Results: After exclusions there were 31 patients in the Placebo group and 29 in the Dex group. At baseline there were no differences in the age, ASA, BMI or CR‐POSSUM scores. Dexamethasone was associated with a significant reduction in Interleukin‐6 (IL‐6) and IL‐13 in the peritoneum and IL‐6 and IL‐8 in plasma. Subsequently, patients in the Dex group had lesser POF and fatigue impact scores at days 3 and 7. Patients in the Dex group had less post‐op nausea and vomiting. There was no significant increase in complications.Conclusion: Preoperative Dexamethasone administration is associated with a significantly diminished post‐operative pro‐inflammatory reaction which is associated with clinical benefits in POF and its impact. This intervention may be an effective method of improving outcomes for patients undergoing major colonic surgery within a multimodal enhanced peri‐operative care pathway.

Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study

Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effect on other surgical outcomes such as pain and fatigue have been unclear. The purpose of this clinical study was to evaluate the efficacy of preoperative dexamethasone in ameliorating postoperative symptoms after LC. In this prospective, double-blind, placebo-controlled study, 80 patients scheduled for LC were analyzed after randomization to intravenous dexamethasone (8 mg) or placebo. All patients underwent standardized procedures for general anesthesia and surgery, and were recommended to remain in hospital for 3 postoperative days. Episodes of PONV, and pain and fatigue scores on a visual analogue scale (VAS) were recorded. Analgesic and antiemetic requirements were also recorded. There were no apparent side effects of the study drug. Seven patients (18%) in the dexamethasone group reported nausea, compared with 16 (40%) in the placebo group (p = 0.026). One patient (3%) in the dexamethasone group and 7 (18%) in the placebo group reported vomiting (p = 0.025). Dexamethasone significantly reduced the postoperative VAS pain score (p = 0.030) and VAS fatigue score (p = 0.023). The mean number of patients requiring diclofenac sodium 50 mg was 0.9 +/- 1.3 in the dexamethasone group and 2.2 +/- 2.5 in the placebo group (p = 0.002). The regimen we employed is safe and without apparent side effects. These results suggest that preoperative dexamethasone (8 mg) significantly reduces the incidence of PONV, pain, and fatigue after LC.

Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy

Tonsillectomy is one of the most frequently performed ambulatory surgical procedures in children (Litman et al. in Anesth Analg 78:478-481, 1994). Several techniques have been described for alleviation of pain (Ginstrom et al. in Acta Otolaryngol 125:972-975, 2005). the objective of this study determination of the postoperative analgesic efficacy of the pre-surgical intravenous administration of dexamethasone together with glossopharyngeal nerve block (GNB) in children undergoing tonsillectomy. Prospective double blind randomized control study using both pre-operative injection of 0.5 mg/kg dexamethasone iv and 3 ml of 0.5% bupivacaine local injection for bilateral glossopharyngeal nerve block. Patients in group B had significantly less visual analogue scale values, longer absolute analgesia time, lesser swallowing difficulty and they were discharged earlier from the hospital when compared to patients in both groups D and G. Using both pre-operative dexamethasone IV injection with GNB has reduced postoperative pain and morbidity to a great extent than using either alone.

Analgésie par voie générale pour la prise en charge des douleurs postopératoires chez l’adulte

Severe postsurgical pain contributes to prolonged hospital stay and is also believed to be a risk factor for the development of chronic pain. Locoregional anesthesia, which results in faster patient recovery with fewer side effects, is favored wherever feasible, but is not applicable to every patient. Systemic analgesics are the most widely used method for providing pain relief in the postoperative period. Improvements in postoperative systemic analgesia for pain management should be applied and predictive factors for severe postoperative pain should be anticipated in order to control pain while minimizing opioid side effects. Predictive factors for severe postoperative pain include severity of preoperative pain, prior use of opiates, female gender, non-laparoscopic surgery, and surgeries involving the knee and shoulder. Pre- and intraoperative use of small doses of ketamine has a preventive effect on postoperative pain. Multimodal or balanced analgesia (the combined use of various analgesic agents) such as NSAID/morphine, NSAID/nefopam, morphine/ketamine improves analgesia with morphine-sparing effects. Nausea and vomiting, the principle side effects of morphine, can be predicted using Apfel's simplified score; patients with a high Apfel score risk should receive preemptive antiemetic agents aimed at different receptor sites, such as preoperative dexamethasone and intraoperative droperidol. Droperidol can be combined with morphine for postoperative patient-controlled anesthesia (PCA). When PCA is used, dosage parameters should be adjusted every day based on pain evaluation. Patients with presurgical opioid requirements will require preoperative administration of their daily opioid maintenance dose before induction of anesthesia: PCA offers useful options for effective postsurgical analgesia using a basal rate equivalent to the patient's hourly oral usage plus bolus doses as required.