The Impact of Prophylactic Dexamethasone on Nausea and Vomiting after Thyroidectomy: A Systematic Review and Meta-Analysis

Abstract

BackgroundWe carried out a systematic review and meta-analysis to evaluate the impact of prophylactic dexamethasone on post-operative nausea and vomiting (PONV), post-operative pain, and complications in patients undergoing thyroidectomy.MethodsWe searched Pubmed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) that evaluated the prophylactic effect of dexamethasone versus placebo with or without other antiemetics for PONV in patients undergoing thyroidectomy. Meta-analyses were performed using RevMan 5.0 software.ResultsThirteen RCTs that considered high quality evidence including 2,180 patients were analyzed. The meta-analysis demonstrated a significant decrease in the incidence of PONV (RR 0.52, 95% CI 0.43 to 0.63, P<0.00001), the need for rescue anti-emetics (RR 0.42, 95% CI 0.30 to 0.57, P<0.00001), post-operative pain scores (WMD –1.17, 95% CI –1.91 to –0.44, P = 0.002), and the need for rescue analgesics (RR 0.65, 95% CI 0.50–0.83, P = 0.0008) in patients receiving dexamethasone compared to placebo, with or without concomitant antiemetics. Dexamethasone 8–10mg had a significantly greater effect for reducing the incidence of PONV than dexamethasone 1.25–5mg. Dexamethasone was as effective as other anti-emetics for reducing PONV (RR 1.25, 95% CI 0.86–1.81, P = 0.24). A significantly higher level of blood glucose during the immediate post-operative period in patients receiving dexamethasone compared to controls was the only adverse event.ConclusionsProphylactic dexamethasone 8–10mg administered intravenously before induction of anesthesia should be recommended as a safe and effective strategy for reducing the incidence of PONV, the need for rescue anti-emetics, post-operative pain, and the need for rescue analgesia in thyroidectomy patients, except those that are pregnant, have diabetes mellitus, hyperglycemia, or contraindications for dexamethasone. More high quality trials are warranted to define the benefits and risks of prophylactic dexamethasone in potential patients with a high risk for PONV.

Clinical Efficacy of Intravenous Lidocaine for Thyroidectomy: A Prospective, Randomized, Double‐Blind, Placebo‐Controlled Trial

“…This finding may be logical, considering our finding that the reduction in fentanyl consumption was correlated with postoperative nausea scores. In addition, although the mechanism of postoperative nausea after thyroidectomy is not clear, intense vagal stimulation during surgical manipulation of the neck may contribute [7,8]. Lidocaine may suppress the The reduction in pain after thyroidectomy, together with reduced postoperative nausea, suggests that intravenous lidocaine improves the quality of recovery.…”

“…Postoperative nausea and vomiting (PONV) also occurs following thyroid surgery [5][6][7]. Although the mechanisms of PONV after thyroidectomy are not clear, stimulation of vagal afferents and inflammatory responses resulting from surgical injury of the neck structure may be responsible [7,8]. Lidocaine may effectively control both pain and PONV after thyroidectomy.…”

Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)

“…17 A meta-analysis of patients undergoing thyroidectomy found that dexamethasone at 8-10 mg had the greatest effect in reducing PONV. 18 The DREAMS trial examined whether preoperative dexamethasone reduces postoperative vomiting in patients undergoing elective gastrointestinal surgery. Reduction of PONV in this group of patients could improve the surgical experience and also fast track recovery and decrease postoperative complications.…”

Effect of perioperative dexamethasone on subjective voice quality after thyroidectomy: a meta-analysis and systematic review

“…It has been shown that dexamethasone effectively reduced PONV and postoperative pain in patients undergoing thyroidectomy [18,19,21,22]. In addition, higher dexamethasone doses (8-10 mg) are generally more effective than lower dexamethasone doses (1.25-5 mg) [22].…”

“…In addition, higher dexamethasone doses (8-10 mg) are generally more effective than lower dexamethasone doses (1.25-5 mg) [22]. The timing of dexamethasone administration is also an important factor.…”