Randomized Clinical Trial of Preoperative High-Dose Methylprednisolone on Postoperative Pain at Rest After Laparoscopic Appendectomy

Kleif, Jakob; Hauge, Camilla Ibsen; Vilandt, Jesper; Gögenur, Ismail

doi:10.1213/ane.0000000000002693

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…The reduction in postoperative hospital stay during the transition from open to laparoscopic appendectomy was to be expected as laparoscopic appendectomy has been shown to reduce postoperative stay when compared to open appendectomies (2). The median postoperative stay during the end of the study period corresponds well with the median postoperative stay reported in clinical trials on adult patients undergoing surgery for appendicitis during the same period in Denmark (17)(18)(19).…”

Section: Discussionsupporting

confidence: 58%

“…2 The median postoperative stay during the end of the study period corresponds well with the median postoperative stay reported in clinical trials on adult patients undergoing surgery for appendicitis during the same period in Denmark. [17][18][19] The reduced mortality was mostly driven by a reduced mortality for complicated cases and for elder patients. The increased use of minimal invasive surgery during the study period seems to have benefited the more fragile patients.…”

Section: Discussionmentioning

confidence: 99%

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Moving from an era of open appendectomy to an era of laparoscopic appendectomy: A nationwide cohort study of adult patients undergoing surgery for appendicitis

2021

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Background and Aims: During the last decades, laparoscopic surgery has been introduced as an alternative to open surgery. We aimed to examine to what extent laparoscopic surgery has replaced open surgery for appendicitis in an entire nation during the last two decades. Second, we examined the effects of shifting to laparoscopic surgery for appendicitis on different quality indicators such as length of postoperative stay and mortality. We also examined age as a predictor of 30-day mortality. Materials and Methods: During the period 2000 to 2015, all adult patients with appendicitis and surgical removal of the appendix were identified in the Danish National Patient Register. Demographics, type of surgery, time of surgery, and duration of postoperative stay were retrieved form Danish National Patient Register. Vital status was retrieved from the Danish Civil Registration System. Results: A total of 58,093 patients underwent surgery for appendicitis. In 2000, a total of 274 out of 3717 (7.4%) had a laparoscopic appendectomy, and the postoperative stay was 55 (iqr: 35–88) h and 30-day mortality was 0.91%. In 2015, a total of 3995 out of 4296 (93.0%) had a laparoscopic appendectomy, and the postoperative stay was 16 (iqr: 9–56) h and 30-day mortality was 0.40%. Age as a predictor of 30-day postoperative mortality had an area under the curve of 0.93 (95% confidence interval: 0.92; 0.94). Conclusion: In Denmark, the standard surgical procedure for appendicitis has changed from open surgery to laparoscopic surgery during the period 2000–2015. At the same time, duration of postoperative stay and 30-day mortality has decreased.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Moving from an era of open appendectomy to an era of laparoscopic appendectomy: A nationwide cohort study of adult patients undergoing surgery for appendicitis

2021

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“…In a meta-analysis evaluation, it was stated that peri-operative single-dose glucocorticoid administration reduced the incidence of PONV in large abdominal operations [8]. Despite the results of this study, in a similar study conducted in laparoscopic appendectomy patients, it was suggested that pre-operative administration of8 mg dexamethasone did not produce a reduction in the incidence of PONV, and pre-operative dexamethasone administration was not recommended for the prevention of PONV [14]. In another study conducted in orthopedic surgery patients, 125 mg MP was administered pre-operatively, and it was found to lead to a reduction in PONV.…”

Section: Discussionmentioning

confidence: 63%

“…In another study addressing this issue, the postoperative comfort in patients who had received pre-operative MP was evaluated using a questionnaire. Parameters, such as sleep quality, PONV, unaided mobilization, and fatigue were questioned in the questionnaire, and it was revealed that preoperative MP administration did not increase patient satisfaction [14]. Preventing nausea and vomiting after surgery and reducing pain are important for patient comfort.…”

Section: Discussionmentioning

confidence: 99%

Can intra-operative methylprednisolone application be effective for post-operative pain, nausea and vomiting in laparoscopic cholecystectomy operations?

Aladağ

Yucel

2022

J Surg Med

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Background/Aim: Post-operative nausea, vomiting (PONV), and pain are common symptoms after laparoscopic cholecystectomy (LC) that is performed under general anesthesia. These symptoms lead to prolongation of post-operative recovery and hospital stay. In this study, the efficacy of intra-operative methylprednisolone (MP) administration on post-operative pain and PONV was investigated in patients undergoing LC under general anesthesia. Methods: This study was conducted at Uşak University Faculty of Medicine Hospital. Patients who underwent LC under general anesthesia between 01.11.2018 and 01.06.2019 were evaluated using the prospective cohort method. While intra-operative MP was administered to one group of patients who underwent LC (MP group), MP was not administered to the second group (non-MP). The pain was evaluated using the Visual Analog Scale (VAS) while PONV was evaluated with the Verbal Descriptive Scale (VDS in patients at post-operative hours 0, 1, 2, 6, 12, 18, and 24. On the first post-operative day, patient satisfaction was assessed. Results: The study cohort consisted of 76 patients. The VAS was used to measure post-operative pain, and it was discovered that the MP group had significantly reduced VAS values at post-operative hours 0, 1, 2, 6, 12, 18, and 24 (P < 0.001). In the VDS evaluation, no difference between the two groups only at post-operative hour 12 (P = 0.52) was found, while the VDS value was found to be lower in the MP group than in the non-MP group at post-operative hours 0, 1, 2, 6, 18, and 24 (P ˂ 0.001). The mean total analgesic use at post-operative hour 48 was 69.08 (26.91) mg in the MP group and 96.71 (42.38) mg in the non-MP group. The difference was statistically significant (P ˂ 0.001). Conclusion: PONV and discomfort incidence decreased after intra-operative MPadministration. The decrease in these symptoms was positively reflected in post-operativepatient satisfaction.

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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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Randomized Clinical Trial of Preoperative High-Dose Methylprednisolone on Postoperative Pain at Rest After Laparoscopic Appendectomy

Abstract: A 125-mg dose of methylprednisolone given intravenously 30 minutes before laparoscopic surgery for appendicitis seemed no better than placebo at providing a clinical meaningful reduction in postoperative pain at rest.

Cited by 8 publications

References 17 publications

Moving from an era of open appendectomy to an era of laparoscopic appendectomy: A nationwide cohort study of adult patients undergoing surgery for appendicitis

Moving from an era of open appendectomy to an era of laparoscopic appendectomy: A nationwide cohort study of adult patients undergoing surgery for appendicitis

Can intra-operative methylprednisolone application be effective for post-operative pain, nausea and vomiting in laparoscopic cholecystectomy operations?

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

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