title: Dexamethasone for the prevention of recurrent laryngeal nerve palsy and other complications after thyroid surgery: a randomized double-blind placebo-controlled trial.
abstract: OBJECTIVE
  Recurrent laryngeal nerve dysfunction and hypoparathyroidism are well-recognized, important complications of thyroid surgery. The duration of convalescence after noncomplicated thyroid operation may depend on several factors, of which pain and fatigue are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. However, there is little information in the literature on the use of steroids in thyroid surgery, and the information that is available is conflicting.
  
  
  OBJECTIVE
  To investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing thyroid surgery.
  
  
  METHODS
  A randomized double-blind placebo-controlled trial. A 30-day follow-up for morbidity was performed in all cases.
  
  
  METHODS
  All patients were hospitalized in a public hospital.
  
  
  METHODS
  From June 2008 through August 2011, 328 patients were randomized to receive either intravenous dexamethasone, 8 mg, administered 90 minutes before skin incision, or saline solution (placebo).
  
  
  METHODS
  Intravenous dexamethasone, 8 mg.
  
  
  METHODS
  The primary end points were temporary or permanent recurrent laryngeal nerve palsy. Transient and definitive hypoparathyroidism, pain and fatigue scores, nausea, and the number of vomiting episodes were also registered. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein, interleukin 6, and interleukin 1β levels.
  
  
  RESULTS
  In the dexamethasone group, the rate of temporary recurrent laryngeal nerve palsy (4.9%) was significantly lower compared with the placebo group (8.4%) (P = .04). Also, postoperative transient biochemical hypoparathyroidism occurred more frequently in the placebo group (37.0%) than in the dexamethasone group (12.8%). Dexamethasone use significantly reduced postoperative levels of C-reactive protein (P = .01) and interleukin 6 and interleukin 1β (P = .02), fatigue (P = .01), and overall pain during the first 24 postoperative hours (P = .04), as well as the total analgesic (ketorolac tromethamine) requirement (P = .04). Dexamethasone use also reduced nausea and vomiting on the day of operation (P = .045).
  
  
  CONCLUSIONS
  Preoperative administration of dexamethasone, 8 mg, reduced postoperative temporary recurrent laryngeal nerve palsy and hypoparathyroidism rates and reduced pain, fatigue, nausea, and vomiting after thyroid surgery. However, these data require further analysis in randomized prospective studies. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01690806.
authors.affiliation: Department of Surgery, University of L’Aquila, Abruzzo, Italy. schietroma2001@yahoo.it
authors.forename: Mario
authors.initials: M
authors.lastname: Schietroma
authors.forename: Emanuela Marina
authors.initials: EM
authors.lastname: Cecilia
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.forename: Federico
authors.initials: F
authors.lastname: Sista
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Santis
authors.forename: Laura
authors.initials: L
authors.lastname: Lancione
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000187:drug effects; D003907:Dexamethasone / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
chemical_list: D003907:Dexamethasone; D002097:C-Reactive Protein