Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS).
BACKGROUND
Postoperative nausea and vomiting is one of the most common complications affecting patients after surgery and causes significant morbidity and increased length of hospital stay. It is accepted that patients undergoing surgery on the bowel are at a higher risk. In the current era of minimally invasive colorectal surgery combined with enhanced recovery, reducing the incidence and severity of postoperative nausea and vomiting is particularly important. Dexamethasone is widely, but not universally used. It is known to improve appetite and gastric emptying, thus reduce vomiting. However, this benefit is not established in patients undergoing bowel surgery, and dexamethasone has possible side effects such as increased risk of wound infection and anastomotic leak that could adversely affect recovery.


METHODS
DREAMS is a phase III, double-blind, multicenter, randomized controlled trial with the primary objective of determining if preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing elective gastrointestinal resections. DREAMS aims to randomize 1,350 patients over 2.5 years.Patients undergoing laparoscopic or open colorectal resections for malignant or benign pathology are randomized between 8 mg intravenous dexamethasone and control (no dexamethasone). All patients are given one additional antiemetic at the time of induction, prior to randomization. Both the patient and their surgeon are blinded as to the treatment arm.Secondary objectives of the DREAMS trial are to determine whether there are other measurable benefits during recovery from surgery with the use of dexamethasone, including quicker return to oral diet and reduced length of stay. Health-related quality of life, fatigue and risks of infections will be investigated.


BACKGROUND
ISRCTN21973627.
West Midlands Deanery/West Midlands Research Collaborative, Birmingham, UK. emmamowatt@gmail.com
Emma
E
Hamilton
Reena
R
Ravikumar
David
D
Bartlett
Elizabeth
E
Hepburn
Mei-Ju
MJ
Hwang
Nazzia
N
Mirza
Sandeep S
SS
Bahia
Anthony
A
Wilkey
Helen
H
Bodenham Chilton
Kelly
K
Handley
Laura
L
Magill
Dion
D
Morton
D061605:Administration, Intravenous / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage*; D002985:Clinical Protocols; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D004739:England; D006801:Humans; D007902:Length of Stay; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D020127:Recovery of Function; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
D000932:Antiemetics; D003907:Dexamethasone