Jim Kling

October 26, 2010

October 26, 2010 (San Diego, California) — A single preoperative dose of dexamethasone enhances recovery after planned laparoscopic cholecystectomy (LC) surgeries, according to research presented here at the American Society of Anesthesiologists 2010 Annual Meeting.

Previous research has indicated that steroid therapy can reduce the severity of postoperative nausea, vomiting, fatigue, and pain. Researchers at NorthShore University Health System in Evanston, Illinois, conducted a study to examine the effect of an 8-mg dose of dexamethasone on health status, including emotional state, physical comfort, psychological support, physical independence, and pain. They used a validated 40-item quality-of-recovery (QoR-40) scoring system during the first day after hospital discharge following LC surgery.

In the study, 120 patients scheduled for outpatient LC surgery were randomly assigned to receive either dexamethasone (8 mg) or saline (control group) about 1 hour before the surgery, and then received standardized anesthetic management. The team used the QoR-40 to quantify health status preoperatively on the morning of the surgery and 24 hours after discharge from the Ambulatory Surgery Unit. Group assignment was blinded with respect to clinicians, researchers, and patients.

There was no difference between the 2 groups in preoperative global and dimensional QoR-40 scores.

On postoperative day 1, the control group had significantly lower median global QoR-40 scores compared with the dexamethasone group (161 vs 178; P < .0001). Patients in the control group had lower median QoR-40 scores in the dimensions of emotional state (35 vs 41; P < .0001), physical comfort (45 vs 51; P < .001), and pain (26 vs 31; P < .0001). There were no differences in the dimensions of psychological support and physical independence. Patients in the dexamethasone group had a shorter hospital stay by about 70 minutes.

"As anesthesiologists, we've done a great job of making anesthesia much safer over the last 20 years, but patients still suffer a fairly high incidence of adverse effects after surgery, such as nausea, vomiting, pain, loss of appetite, fatigue, headache, and dizziness. Our study demonstrates in patients having outpatient procedures that the use of a small dose of steroid can significantly enhance the quality of recovery," Glenn Murphy, MD, director of clinical research at NorthShore University Health System, who presented the research, told Medscape Medical News.

Dr. Murphy acknowledged concerns that steroid use could cause hyperglycemia and an increased risk for wound infection. His team has 2 other ongoing trials looking at hyperglycemia, and the first showed no increased risk for hyperglycemia. He added that previous research has not revealed an increase in wound infection. "My guess is that with a short-term steroid dose, there's probably a low risk of infection."

The results are similar to previous trials showing that dexamethasone reduces postsurgical adverse effects. "The difference is that they evaluated the quality of recovery. Previous trials tended to focus on single issues, such as nausea and vomiting. This is a much more global score, with fatigue, function, [and emotional state]. It's definitely an advantage," Daniel Sessler, MD, professor of outcomes research at the Cleveland Clinic, in Ohio, who moderated the session, told Medscape Medical News.

The trial was relatively small. "What's needed now is a really large trial in noncardiac patients," said Dr. Sessler.

Dr. Murphy and Dr. Sessler have disclosed no relevant financial relationships.

American Society of Anesthesiologists 2010 Annual Meeting: Abstract 1184. Presented October 18, 2010.


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