title: Dexamethasone for morbidity after subdural electrode insertion--a randomized controlled trial.
abstract: BACKGROUND
  Invasive monitoring with subdural electrodes (SDE) for investigation of medically intractable epilepsy may be associated with undesirable immediate postoperative morbidity such as headache, nausea, vomiting, fever, and meningism. We undertook to evaluate the potential beneficial role of perioperative dexamethasone in reducing these symptoms.
  
  
  METHODS
  In a double-blind placebo controlled clinical trial 30 patients undergoing SDE insertion were randomized to receive either placebo or a course of dexamethasone beginning one hour prior to surgery and tapering to discontinue over 72 hours postoperatively. Pain, pain relief, nausea, nausea relief, temperature, and meningism were assessed regularly in the postoperative period, and analgesic, antipyretic, and antiemetic drug requirements were tabulated.
  
  
  RESULTS
  One patient was withdrawn from the dexamethasone group due to lack of data. With regards to postoperative pain, the direction of benefit favoured dexamethasone but a significant treatment by time interaction prevented further analysis of treatment effect. The dexamethasone group did have significantly lower temperatures and higher nausea relief scores. There was no statistically significant difference between the groups with regards to pain relief, nausea, and meningism scores. The beneficial effects of dexamethasone were delayed in onset, of limited duration, and not uniform over the observation period.
  
  
  CONCLUSIONS
  Dexamethasone appears to have a role in reducing immediate morbidity following SDE insertion but its effect is not uniform in the postoperative period; it appears to be delayed in onset, and of limited duration. Further study is necessary to determine the ideal dosing schedule.
authors.affiliation: Division of Neurosurgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Ramesh L
authors.initials: RL
authors.lastname: Sahjpaul
authors.forename: Jeff
authors.initials: J
authors.lastname: Mahon
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D003907:Dexamethasone