High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial†

Bjerregaard, Lars S; Jensen, Per; Bigler, D; Petersen, René Horsleben; Møller‐Sørensen, Hasse; Gefke, Kaj; Hansen, Henrik Jessen; Kehlet, Henrik

doi:10.1093/ejcts/ezx248

Cited by 30 publications

(25 citation statements)

References 22 publications

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“…Bjerregaard et al. [ 18 ] compared high‐dose methylprednisolone (125 mg) before surgery with placebo. Baseline analgesia included paracetamol, ibuprofen and gabapentin, supplemented by paravertebral block and an intercostal nerves block, with morphine or a bolus of bupivacaine in the intercostal nerves block given as rescue.…”

Section: Resultsmentioning

confidence: 99%

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2021

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Video-assisted thoracoscopic surgery has become increasingly popular due to faster recovery times and reduced postoperative pain compared with thoracotomy. However, analgesic regimens for video-assisted thoracoscopic surgery vary significantly. The goal of this systematic review was to evaluate the available literature and develop recommendations for optimal pain management after video-assisted thoracoscopic surgery. A systematic review was undertaken using procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials published in the English language, between January 2010 and January 2021 assessing the effect of analgesic, anaesthetic or surgical interventions were identified. We retrieved 1070 studies of which 69 randomised controlled trials and two reviews met inclusion criteria. We recommend the administration of basic analgesia including paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2-specific inhibitors pre-operatively or intra-operatively and continued postoperatively. Intra-operative intravenous dexmedetomidine infusion may be used, specifically when basic analgesia and regional analgesic techniques could not be given. In addition, a paravertebral block or erector spinae plane block is recommended as a first-choice option. A serratus anterior plane block could also be administered as a secondchoice option. Opioids should be reserved as rescue analgesics in the postoperative period.

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Section: Resultsmentioning

confidence: 99%

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2021

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“…As for methylprednisolone, Bjerregaard et al found that high-dose preoperative intravenous methylprednisolone significantly reduced pain but increased blood glucose levels on the day of surgery in patients undergoing VATS to lobectomy under general anesthesia combined with TPVB and an intercostal catheter. 37 As for dexamethasone, Murphy et al demonstrated that the peak serum glucose concentration occurred about 2 hours after the administration of dexamethasone and serum glucose levels did not significantly differ among the groups receiving dexamethasone at a dose of 4 mg and 8 mg as well as saline at any measurement time point. 38 In our study, even though we excluded patients with contraindications to corticosteroid therapy and used a single intermediate dose of dexamethasone, two patients without diabetes mellitus developed intraoperative hyperglycemia after the administration of the drug.…”

Section: Discussionmentioning

confidence: 99%

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery

Termpornlert¹,

Vijitpavan²,

Ngodngamthaweesuk³

et al. 2022

JPR

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Purpose Thoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS. Patients and Methods In this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1–3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed. Results After excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) ( P value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups. Conclusion Intravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.

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“…However, there were no significant differences in pain scores or opioid consumption during admission. Studies of other procedures have shown conflicting results on the analgesic effects of GCs, with some reporting a reduction in postoperative pain scores 25–27 , and others no difference between groups 28–30 . Apart from explaining the different conclusions in terms of small study populations, differences in doses, outcome measures, and statistical analyses, there are most likely also procedure-specific differences in the magnitude of the inflammatory response and the mechanisms of pain.…”

Section: Discussionmentioning

confidence: 99%

Preoperative high-dose glucocorticoids for early recovery after liver resection: randomized double-blinded trial

et al. 2021

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Background Glucocorticoids modulate the surgical stress response. Previous studies showed that high-dose preoperative glucocorticoids reduce levels of postoperative inflammatory markers and specific biomarkers of liver damage compared with placebo, and suggested a reduced complication rate and shorter hospital stay after liver surgery. However, there are no studies with a clinical primary outcome or of early recovery outcomes. The aim of this study was to investigate whether a single high dose of preoperative glucocorticoid reduces complications in the immediate postoperative phase after liver surgery. Methods This was a single-centre, double-blinded, parallel-group RCT investigating preoperative methylprednisolone 10 mg/kg (high dose) versus dexamethasone 8 mg (standard-dose postoperative nausea prophylaxis) in patients scheduled for open liver resection. The primary outcome was number of patients with a complication in the postanaesthesia care unit; secondary outcomes included duration of hospital stay, pain and nausea during admission, and 30-day morbidity. Results A total of 174 patients (88 in high-dose group, 86 in standard-dose group) were randomized and analysed (mean(s.d.) age 65(12) years, 67.2 per cent men); 31.6 per cent had no serious co-morbidities and 25.3 per cent underwent major liver resection. Complications occurred in the postanaesthesia care unit in 51 patients (58 per cent) in the high-dose group and 58 (67 per cent) in the standard-dose group (risk ratio 0.86, 95 per cent c.i. 0.68 to 1.08; P = 0.213). Median duration of hospital stay was 4 days in both groups (P = 0.160). Thirty-day morbidity and mortality rates were similar in the two groups. Conclusion A high dose of preoperative glucocorticoids did not reduce acute postoperative complications after open liver resection compared with a standard dose. Registration number: NCT03403517 (http://www.clinicaltrials.gov); EudraCT 2017–002652-81 (https://eudract.ema.europa.eu/).

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High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial†

Abstract: Registered at clinicaltrialsregister.eu [7 November 2012, EudraCT 2012-004451-37; https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-004451-37/DK].

Cited by 30 publications

References 22 publications

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery

Preoperative high-dose glucocorticoids for early recovery after liver resection: randomized double-blinded trial

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