Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy.
BACKGROUND
Recent data have suggested a relationship between postoperative fatigue and the peritoneal cytokine response after surgery. The aim of this study was to test the hypothesis that preoperative administration of glucocorticoids before surgery would decrease fatigue and enhance recovery, by reducing the peritoneal production of cytokines.


METHODS
In a double-blind randomized controlled study, patients undergoing elective, open colonic resection were administered 8 mg dexamethasone or normal saline. Patients were treated within an enhanced recovery after surgery programme. Primary outcomes were cytokine levels in peritoneal drain fluid and fatigue as measured by the Identity-Consequence Fatigue Scale (ICFS).


RESULTS
Baseline parameters were similar for 29 patients in the dexamethasone group and 31 in the placebo group. Patients who received dexamethasone had lower ICFS scores on days 3 and 7. Dexamethasone was associated with significantly lower peritoneal fluid interleukin (IL) 6 and IL-13 concentrations on day 1, and these correlated with changes in the ICFS score. There was no significant increase in adverse events in the dexamethasone group.


CONCLUSIONS
Preoperative administration of dexamethasone resulted in a significant reduction in early postoperative fatigue, associated with an attenuated early peritoneal cytokine response. Peritoneal production of cytokines may therefore be important in postoperative recovery.


BACKGROUND
ACTRN12607000066482 (http://www.anzctr.org.au/).
Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
K
K
Zargar-Shoshtari
T
T
Sammour
A
A
Kahokehr
A B
AB
Connolly
A G
AG
Hill
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003082:Colectomy; D016207:Cytokines / Q000378:metabolism; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005221:Fatigue / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D005938:Glucocorticoids; D003907:Dexamethasone