Randomized Controlled Trial: Perioperative Dexamethasone Reduces Excessive Postoperative Inflammatory Response and Ileus After Surgery for Inflammatory Bowel Disease

Abstract

Background An excessive postoperative inflammatory response is common after surgery for inflammatory bowel disease (IBD) and may be associated with an increased incidence of postoperative ileus. This study assessed the role of perioperative dexamethasone in postoperative ileus after IBD surgery. Method Patients undergoing elective IBD surgery were randomized to either an intravenous 8-mg dose of dexamethasone (n = 151) or placebo (n = 151) upon induction of anesthesia. The primary outcome was the incidence of prolonged postoperative ileus. Secondary outcomes included incidence of reported nausea or vomiting, time to first passage of flatus and stool, GI-2 recovery, postoperative pain, length of stay, and surgical complications. Results An intention-to-treat analysis revealed that patients who received dexamethasone exhibited a lower incidence of prolonged postoperative ileus (22.5% vs 38.4%; P = 0.003), shorter time to first passage of stool (28 vs 48 h, P < 0.001), GI-2 recovery (72 vs 120 h; P < 0.001), reduced postoperative length of stay (9.0 vs 10.0 d; P = 0.002), and less postoperative pain (P < 0.05) compared with controls. Moreover, there were no significant differences in postoperative nausea or vomiting (P = 0.531), major postoperative complications (P = 0.165), or surgical site infections (P = 0.337) between the groups. A benefit was only observed in patients with Crohn’s disease, restored bowel continuity, colon/rectal resections, and those who underwent open operations. Conclusion A single, intravenous 8-mg dose of dexamethasone upon induction of anesthesia reduced the incidence of prolonged postoperative ileus, the intensity of postoperative pain, and shortened the postoperative length of stay for IBD patients undergoing elective surgery. ClinicalTrials.gov: NCT03456752.

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update

“…In patients undergoing surgery for gastrointestinal cancer, corticosteroids administered preoperatively or following induction of anaesthesia has been associated with fewer complications and a milder systemic inflammatory response (SIR) [51,52]. In elective surgery for inflammatory bowel disease, a single dose of 8 mg dexamethasone upon induction of anaesthesia reduced postoperative ileus, the intensity of postoperative pain, and LOS [53]. Perioperative dexamethasone for total joint arthroplasty patients was also associated with reduced LOS, postoperative pain and stress response as reported in one meta-analysis including 17 RCTs [54].…”

Post-Operative Ileus After Digestive Surgery: Network Meta-Analysis of Pharmacological Intervention.

“…Four compared non-steroidal anti-inflammatory drugs to placebo [11][12][13][14] . One study compared glucocorticoids (dexamethasone) to placebo 17 . Two compared erythromycin to placebo 18,19 .…”

“…From the literature, 33 studies reporting the time to first flatus were included although 27 give useable data for statistical analysis 11,[13][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29]32,[36][37][38][39][40][41]44,45,48 . A total of 27 studies with 4,351 patients and 9 pharmacological treatments are reported.…”

“…According to the literature, 18 studies reporting the number of patients requiring postoperative nasogastric tube placement were included although 13 give useable data for statistical analysis [17][18][19]21,23,26,28,32,33,36,41,45,47 . A total of 13 studies with 2,803 patients and 6 pharmacological treatments are reported.…”

Acetyl‐11‐keto‐β‐boswellic Acid Confers Protection in DSS‐Induced Colitis via the JNK–p38 MAPK and NF‐κB Signaling Pathways

“…[6] Adrenocorticotropic agents such as dexamethasone and cortisone are also used in the clinical treatment of IBD and have good effects on the remission of acute enteritis, but long-term administration can lead to various side effects, including hypertension, osteoporosis, and so on. [7] Further, immunological agents such as cyclosporine A will also be used in the treatment of IBD, and they restrained inflammation by inhibiting the proliferative activation of immune cells and the chemotaxis of neutrophils, but there is still slow onset, immunosuppressive side effects. [8] Therefore, it is crucial to find new IBD therapeutics with high efficiency, low cost, and low side effects, and this is also one of the important directions in the research of IBD at this stage.Clinical studies based on evidence-based medicine have shown that although IBD is classified as an intractable disease by the World Health Organization, traditional Chinese medicine (TCM) has displayed some characteristics and advantages in improving clinical symptoms and ameliorating the quality of life for IBD patients.…”