title: Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer.
abstract: BACKGROUND
  Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.
  
  
  METHODS
  In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (n = 35) or placebo (n = 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.
  
  
  RESULTS
  Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% vs. 60%; p = 0.02) and at 6 h (17.2% vs. 45.8%; p = 0.03). More patients in the placebo group required additional antiemetic medication (21 vs. 8; p = 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 vs. 5.83 ± 2.00; p = 0.004), at 6 h (3.03 ± 1.20 vs. 4.17 ± 1.24; p < 0.0005) and at 12 h (2.09 ± 0.85 vs. 2.54 ± 0.98; p = 0.04). Analgesics were required in more patients of the control group (21 vs. 10; p = 0.008). There were no adverse events, morbidity or mortality.
  
  
  CONCLUSIONS
  Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.
  
  
  BACKGROUND
  NCT01116713.
authors.affiliation: Breast Tumor Clinic. Oncologic Institute of Jalisco, Health Secretary, CalleCoronel Calderon 715, Colonia El Retiro, Postal code 44280, Guadalajara, Jalisco, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gómez-Hernández
authors.forename: Alba Lorena
authors.initials: AL
authors.lastname: Orozco-Alatorre
authors.forename: Marisela
authors.initials: M
authors.lastname: Domínguez-Contreras
authors.forename: Antonio
authors.initials: A
authors.lastname: Oceguera-Villanueva
authors.forename: Salvador
authors.initials: S
authors.lastname: Gómez-Romo
authors.forename: Andrea Socorro
authors.initials: AS
authors.lastname: Alvarez Villaseñor
authors.forename: Clotilde
authors.initials: C
authors.lastname: Fuentes-Orozco
authors.forename: Alejandro
authors.initials: A
authors.lastname: González-Ojeda
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D000932:Antiemetics / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000601:surgery*; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008408:Mastectomy / Q000009:adverse effects*; D008800:Mexico; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D015990:Placebo Effect; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000932:Antiemetics; D003907:Dexamethasone