Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial

Abstract

The objective was to evaluate whether pre operative administration of dexamethasone improved post operative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a pre operative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05).Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional post operative analgesic and antiemetic drugs. K E Y W O R D Sdexamethasone, mastectomy, nausea, postoperative pain, respiratory function tests, vomiting | INTRODUCTIONGlobally, breast cancer (BC) remains the most common malignancy in women. In developing countries, such as Mexico there has been an increase in mortality caused by BC (Rodríguez-Cuevas, GuisaHohenstein & Labastida-Almendaro, 2009;Siegel, Ma, Zou & Jemal, 2014). It is the most common cancer in this country, followed by cervical intraepithelial neoplasia; each year 25,000-30,000 new cases are diagnosed. Fortunately, more patients now have access to proper screening using mammography, so the proportion of patients with local tumours found at diagnosis is increasing. Total or partial mastectomy with or without axillary lymph node dissection is the most frequently used surgical treatment, along with adjuvant chemoor radiotherapy. Post operative nausea and vomiting (PONV) is a common complication after anaesthesia and surgery (Kovac, 2000;Watcha & White, 1992). Women undergoing mastectomy are at particularly high risk for developing PONV, and the reported incidence is 60%-80% in patients not receiving antiemetic medication (Hammas, Thorn & Wattwil, 2002;Oddby-Muhrbeck, Jakobsson, Andersson & Askergren, 1994;Sadhasivam et al., 1999). Emetic episodes predispose patients to numerous complications, such as gastric aspiration, wound dehiscence, psychological distress, and delayed recovery and discharge times (Watcha & White, 1992). These reasons justify the use of prophylactic antiemetics in women scheduled for breast surgery. In addition, respiratory function is often compromised after a major surgical procedure, particularly those p...

Adverse side‐effects of dexamethasone in surgical patients – an abridged Cochrane systematic review

“…Six of the included studies used a low dose (4–5 mg) of dexamethasone . Twenty‐six included studies used an intermediate dose of dexamethasone (8–10 mg) . Seven groups studied a high dose of dexamethasone (12–20 mg) .…”

“…Two studies were conducted with an open‐label control group, which received a placebo and two studies were conducted in a blinded fashion; however, the control group did not receive a placebo . All other studies were blinded and were conducted with a placebo group . In 20 studies, participants with diabetes were eligible for inclusion in their respective studies .…”

“…Three studies used their own criteria, which included, for example, treatment with antibiotics . Sixteen studies did not report the definition used for scoring a postoperative systemic or wound infection .…”

“…We pooled the results of 26 studies to estimate the effects of dexamethasone on postoperative wound or systemic infection rates . These studies included 4603 participants in total: 2353 in the intervention group and 2250 in the control group.…”

Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

“…[ 13 14 15 ] Dexamethasone 8 mg is effective and safe for the prevention of PONV following different medical and surgical conditions. [ 15 16 17 18 19 ] Multimodal approach to PONV has been advocated in recent guidelines and medical literature[ 11 12 13 ] With a better understanding of pathophysiology of PONV involving different sets of receptors, combination therapy with antiemetics acting through different pathways appear to be the logical choice. A fair number of trials had shown the efficacy of dexamethasone as an antiemetic.…”