Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy?
BACKGROUND
Stress response after laparoscopic cholecystectomy (LC) is less compared with open cholecystectomy, but is still responsible for significant postoperative morbidity. Though preoperative glucocorticoids were found to be effective in reducing the response in open surgical procedures, their role in minimal access surgery is not clear.


OBJECTIVE
To evaluate the efficacy of single-dose preoperative dexamethasone in reducing the stress response and postoperative morbidity after LC.


METHODS
In a prospective randomized, double-blind, placebo-controlled trial, 70 patients undergoing elective LC were randomized to receive either dexamethasone (8 mg intravenously), or placebo. The change in C-reactive protein levels after LC, pain scores at rest, and on exertion and narcotic requirements, the incidence and severity of postoperative nausea and vomiting (PONV), anti-emetic requirement, peak expiratory flow rate in both groups were compared.


RESULTS
Dexamethasone was more effective in controlling late PONV (P=0.05). The antiemetic requirement was significantly less in the dexamethasone group (0.56 mg vs. 2.24 mg; P=0.02). Median pain scores were significantly less in the dexamethasone group at 24 hours at rest (P=0.002) and on exertion at 24 and 48 hours (P=0.03 and 0.001). Analgesic requirement was less in the test group (22.9 mg vs. 29.9 mg; P=0.054). The peak expiratory flow rate at 48 hours was higher in the dexamethasone group (315.28 vs. 285.8 l/min; P=0.04). The dexamethasone group showed significantly less elevation of C-reactive protein levels at 24 hours (7.17 microg/mL vs. 17.53 microg/mL; P=0.003) and 48 hours (10.65 microg/mL vs. 23.18 microg/mL; P=0.02) postoperatively.


CONCLUSIONS
Preoperative single-dose dexamethasone significantly reduces the pain scores, PONV, and antiemetic requirements while improving the respiratory function in the postoperative period after LC.
Sistla
Sarath
S
Jawaharlal Institute of Postgraduate Medical, Education and Research, Pondicherry, India. sarathsistla@hotmail.com
Rajesh
Rajalingam
R
Sadasivan
Jagdish
J
Kundra
Pankaj
P
Sistla
Sujatha
S
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage; D002097:C-Reactive Protein / Q000378:metabolism; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D017294:Ondansetron / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D010366:Peak Expiratory Flow Rate; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care; D012307:Risk Factors; D012720:Severity of Illness Index; D013312:Stress, Physiological / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000932:Antiemetics; D005938:Glucocorticoids; D017294:Ondansetron; D003907:Dexamethasone; D002097:C-Reactive Protein