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

Abstract

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 (8 mg) intravenously, 90 min 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 (8 mg) reduced pain, fatigue, nausea and vomiting in patients undergoing uncomplicated LNF when compared with placebo.

Randomized clinical trial of preoperative dexamethasone on postoperative nausea and vomiting after laparoscopy for suspected appendicitis

“…Preoperative dexamethasone reduced postoperative fatigue on the first postoperative day in the present trial, consistent with findings for other elective intra‐abdominal surgical procedures.…”

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.…”