title: Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery.
abstract: BACKGROUND
  Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery.
  
  
  METHODS
  This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg(-1) or dexamethasone 0.1 mg kg(-1) before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated.
  
  
  RESULTS
  Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg(-1) 193 (192-195) was greater than dexamethasone 0.05 mg kg(-1) 179 (175-185) (P=0.004) or saline, 171 (160-182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (0-6.3) mg after dexamethasone 0.1 mg kg(-1) compared with 5.3 (2.4-8.8) mg and 5.3 (2.7-7.8) mg after dexamethasone 0.05 mg kg(-1) and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg(-1) compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg(-1) had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg(-1) and saline.
  
  
  CONCLUSIONS
  Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg(-1) reduced opioid consumption compared with dexamethasone 0.05 mg kg(-1), which may be beneficial for improving recovery after ambulatory gynaecological surgery.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St., Feinberg 5-704, Chicago, IL 60611, USA. r-mccarthy@northwestern.edu
authors.forename: G S
authors.initials: GS
authors.lastname: De Oliveira
authors.forename: S
authors.initials: S
authors.lastname: Ahmad
authors.forename: P C
authors.initials: PC
authors.lastname: Fitzgerald
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcus
authors.forename: C S
authors.initials: CS
authors.lastname: Altman
authors.forename: A S
authors.initials: AS
authors.lastname: Panjwani
authors.forename: R J
authors.initials: RJ
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010351:Patient Discharge; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid; D003907:Dexamethasone