Randomized Controlled Trial on Single Dose Steroid Before Thyroidectomy for Benign Disease to Improve Postoperative Nausea, Pain, and Vocal Function

Worni, Mathias; Schudel, Hans H.; Seifert, Eberhard; Inglin, Roman; Hagemann, Matthias; Vorburger, Stephan A.; Candinas, Daniel

doi:10.1097/sla.0b013e31818c709a

Cited by 90 publications

(142 citation statements)

References 37 publications

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“…These findings corroborated with the studies of Worni et al 18 In his study, he found that single preoperative dose of dexamethasone significantly reduced the incidence of PONV, pain and improved the voice function after 48 hours of thyroid resection. In another study of Fujji et al, dexamethasone found to be effective in reducing the incidence of PONV and use of analgesics in patients undergoing middle ear surgery.…”

Section: Discussionsupporting

confidence: 81%

A study to assess the effects of a single preoperative dose of steroid on thyroidectomy

2017

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INTRODUCTIONThyroidectomies are one of the most common elective surgical procedures worldwide.1 Unlike other surgical interventions, where the incidence of postoperative nausea and vomiting is less than 30%, after thyroidectomy the incidence of postoperative nausea and vomiting (PONV) is 70% to 80% when no prophylactic antiemetic therapy is given.2-5 PONV is not only uncomfortable for the patient but repeated or vigorous vomiting can lead to postoperative bleeding with subsequent airway obstruction and potential reparative surgery. 6 The importance of avoiding PONV events was substantiated by the work of Apfel et al who found in preoperative interviews that patients were more afraid of PONV than postoperative pain. 7The exact mechanism of thyroidectomy-related nausea and vomiting is not clearly understood. It is assumed that significant edema and inflammation around the neck tissues may persistently evoke parasympathetic impulses through the vagus, recurrent laryngeal, and ABSTRACT Background: On thyroidectomy, incidence of postoperative nausea and vomiting, severe pain with local inflammation and voice impairment was very common. These effects can be manipulated by the use of steroids. Hence the present study, was conducted with the objective to evaluate the effects of a single preoperative dose of dexamethasone on thyroidectomy in terms of postoperative nausea and vomiting (PONV), pain and voice improvement. Methods: The present study was conducted between October 2010 and March 2011 at the Department of General Surgery, Government Medical College, Kottayam, Kerala, India. A total of 72 patients were included in the study after meeting requirements of inclusion criteria. They were divided into two groups. 37 were under Group C and received normal saline and remaining 35 served as Group D and received 8 mg/2 mL of dexamethasone preoperatively. Post-operative incidences of nausea and vomiting, pain scores, and the improvement of vocal function were compared in both groups. Results: Out of 72 patients, most of the patients participated were under the age group of 40-50 years (30.6%). Of them 9 were males and 63 were females. The incidence and severity of PONV and pain was significantly reduced in Group D compared to Group C with P values of 0.001 and 0.056 respectively. Significant protection of dexamethasone towards vocal function was not observed in the study (p =0.245). Conclusions: From the results obtained in the study, it was concluded that preoperative single dose administration of dexamethasone seemed to be safe in healthy patients undergoing thyroidectomy.

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Section: Discussionsupporting

confidence: 81%

A study to assess the effects of a single preoperative dose of steroid on thyroidectomy

2017

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“…Corticosteroid medications are potent inhibitors of inflammatory responses and have been used in single-dose administration during the perioperative period in thyroid surgery to significantly reduce postoperative nausea and pain. 81,203 While the mechanism by which corticosteroids exert a beneficial effect on nausea and pain is likely to be different than how they might impact voice changes that occur after thyroid surgery, the possibility exists that corticosteroids may also improve voice outcomes by preventing the development of anatomical abnormalities that might result in abnormalities of voice.…”

Section: Action Statement Profilementioning

confidence: 99%

“…81 Voice function was assessed by fundamental voice frequency, the mean fundamental frequency of a sustained "a," as well as by subjective voice function using a modified VHI and by a voice visual analog scale. Dexamethasone significantly reduced the incidence and severity of the postoperative nausea and/or vomiting (P = .001) and significantly reduced postoperative pain (P = .009).…”

Section: Action Statement Profilementioning

confidence: 99%

“…The VHI has been successfully used in several studies to determine pre-and postoperative voice status in those undergoing thyroid surgery. 37,74,[79][80][81] Further, it has been shown to have high levels of diagnostic precision in predicting significant voice changes from pre-to post-thyroid surgery. 74 The VHI-10 is a shorter, alternative version of the original VHI with only 10 questions that may be more practical for quick use.…”

Section: No Recommendationmentioning

confidence: 99%

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Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

352

100

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Objective. Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period.Purpose. The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well.Results. The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesi...

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“…There are studies reporting that a perioperative single-dose administration of dexamethasone (8 mg) is beneficial for postoperative pain control [14,15,16]. On the other hand, Wattwil et al [12] showed that dexamethasone at 4 mg was effective for the prevention of PONV following breast surgery, but they could not demonstrate any difference in postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Effect on Postoperative Pain and Tramadol Requirement after Thyroidectomy

et al. 2013

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Tramadol is a central-acting analgesic associated with nausea and vomiting. Clinical studies have demonstrated that glucocorticoids have analgesic and antiemetic effects when administered perioperatively. The aim of this study is to test the hypothesis that coadministration of tramadol and dexamethasone decreases both postoperative pain and tramadol requirement by patient-controlled analgesia (PCA). Forty female patients undergoing thyroidectomy under general anesthesia were enrolled in a double-blind randomized controlled study and allocated to receive dexamethasone 4 mg i.v. (dexamethasone group, n = 20) or saline (control group, n = 20). At 0, 1, 2, 4 and 22 h of PCA, tramadol consumption and pain were evaluated. Although pain (numerical rating scale 0–10) was significantly lower in the dexamethasone group compared to the control group (2.9 ± 1.4 vs. 3.8 ± 1.2, p = 0.02) at the beginning of PCA, tramadol demand was not significantly different. Although the results herein show a possible beneficial effect of a preoperative single low dose of dexamethasone on postoperative pain, the hypothesis that this corticosteroid decreases tramadol requirement is not supported.

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Randomized Controlled Trial on Single Dose Steroid Before Thyroidectomy for Benign Disease to Improve Postoperative Nausea, Pain, and Vocal Function

Abstract: A preoperative single dose of steroid significantly reduced nausea, vomiting, and pain, and improved postoperative voice function within the first 48 hours (most pronounced within 16 hours) after thyroid resection; this strategy should be routinely applied in thyroidectomies.

Cited by 90 publications

References 37 publications

A study to assess the effects of a single preoperative dose of steroid on thyroidectomy

A study to assess the effects of a single preoperative dose of steroid on thyroidectomy

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Dexamethasone Effect on Postoperative Pain and Tramadol Requirement after Thyroidectomy

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