Article

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

Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, 422-8527, Japan.
Journal of Hepato-Biliary-Pancreatic Surgery (Impact Factor: 1.6). 04/2009; 16(3):367-71. DOI: 10.1007/s00534-009-0079-5
Source: PubMed

ABSTRACT

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.

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    • "Fukami et al. showed that Dexamethasone injection before laparoscopic cholecystectomy leads to significant reduction of nausea, vomiting and post-operative pain. Fukami’s study was a clinical trial performed on 80 patients (10). In another clinical trial performed by Binachin et al. "
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    ABSTRACT: Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy. The current study aimed to compare Dexamethasone effect with that of Granisetron in prevention of PONV. In the current study 104 patients aged 20-60 with ASA class I or II who were candidates for laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of A and B. 15 minutes before anesthesia induction, in group a patient's 3 mg Granisetron and in group B patients 8 mg Dexamethasone was intravenously injected. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed at three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). SPSS software version 16 was employed to analyze data. T test, chi-square test and Fischer exact test were performed level of significance was P < 0.05. There was no significant difference between age, gender proportion, weight, height, and body mass index (BMI) of patients in the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting, and in Granisetron group, five patients experienced nausea and three patients had vomiting after consciousness. Statistical analysis indicated no significant difference between the two groups in this regard. Intravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effects in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.
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    ABSTRACT: 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.
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