Effect of prednisolone on the systemic response and wound healing after colonic surgery.
OBJECTIVE
To study the effect of preoperative treatment with a single high-dose glucocorticoid on the systemic and immunologic responses, wound healing, and convalescence after colonic surgery.


METHODS
Double-blind, placebo-controlled, randomized trial.


METHODS
Department of surgery in a university hospital.


METHODS
Thirty patients scheduled for open colonic resection; 6 patients were excluded from the study (N = 24).


METHODS
Patients were randomized to either of 2 treatment regimens: methylprednisolone sodium succinate 90 minutes before induction of anesthesia and epidural analgesia (group 1, n = 12), or placebo 90 minutes before anesthesia and epidural analgesia (group 2, n = 12).


METHODS
Assessments of pain, pulmonary function, convalescence, and various injury and wound-healing factors were done several times until 10 days after surgery.


RESULTS
Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activations were significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effects on collagen accumulation.


CONCLUSIONS
Treatment with a single high-dose glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.
Schulze
S
S
Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
Andersen
J
J
Overgaard
H
H
Nørgard
P
P
Nielsen
H J
HJ
Aasen
A
A
Gottrup
F
F
Kehlet
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D004311:Double-Blind Method; D005938:Glucocorticoids / Q000494:pharmacology*; D006801:Humans; D007109:Immunity / Q000187:drug effects; D008776:Methylprednisolone Hemisuccinate / Q000494:pharmacology*; D008875:Middle Aged; D011300:Preoperative Care; D014945:Wound Healing / Q000187:drug effects*
D005938:Glucocorticoids; D008776:Methylprednisolone Hemisuccinate