Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial.
OBJECTIVE
To determine the effects of preoperative dexamethasone on surgical outcome after laparoscopic cholecystectomy (LC).


BACKGROUND
Pain and fatigue are dominating symptoms after LC and may prolong convalescence.


METHODS
In a double-blind, placebo-controlled study, 88 patients were randomized to intravenous dexamethasone (8 mg) or placebo 90 minutes before LC. Patients received a similar standardized anesthetic, surgical, and multimodal analgesic treatment. All patients were recommended 2 days postoperative duration of convalescence. The primary endpoints were fatigue and pain. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein (CRP) and pulmonary function, pain scores, nausea, and number of vomiting episodes were registered. Analgesic and antiemetic requirements were recorded. Also, on a daily basis, patients reported scores of fatigue and pain before and during the first postoperative week and the dates for resumption of work and recreational activities.


RESULTS
Eight patients were excluded from the study, leaving 40 patients in each study group for analysis. There were no apparent side effects of the study drug. Dexamethasone significantly reduced postoperative levels of CRP (P = 0.01), fatigue (P = 0.01), overall pain, and incisional pain during the first 24 postoperative hours (P < 0.05) and total requirements of opioids (P < 0.05). In addition, cumulated overall and visceral pain scores during the first postoperative week were significantly reduced (P < 0.05). Dexamethasone also reduced nausea and vomiting on the day of operation (P < 0.05). Resumption of recreational activities was significantly faster in the dexamethasone group versus placebo group (median 1 day versus 2 days) (P < 0.05).


CONCLUSIONS
Preoperative dexamethasone (8 mg) reduced pain, fatigue, nausea and vomiting, and duration of convalescence in patients undergoing noncomplicated LC, when compared with placebo, and is recommended for routine use.
Bisgaard
Thue
T
Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, DK-2650 Hvidovre, Denmark. thuebisgaard@tdcadsl.dk
Klarskov
Birthe
B
Kehlet
Henrik
H
Rosenberg
Jacob
J
D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000032:analysis; D017081:Cholecystectomy, Laparoscopic; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011300:Preoperative Care; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D000932:Antiemetics; D005938:Glucocorticoids; D003907:Dexamethasone; D002097:C-Reactive Protein