title: The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD.
  
  
  METHODS
  The efficacy of intravenous dexamethasone 0.15 mg/kg (DEXA group) compared with saline-only placebo (placebo) for epigastric pain after ESD of early gastric neoplasms was assessed in a double-blinded, placebo-controlled trial. Patients completed a questionnaire about present pain intensity (PPI) and short-form McGill pain (SF-MP) categories for immediate and 6-, 12-, and 24-h postoperative periods. The primary outcome variable was PPI at 6 h following ESD. Secondary outcome variables included pain medication, SF-MP scores, complications, second-look endoscopic findings, and length of stay.
  
  
  RESULTS
  A total of 36 patients participated in the study. The mean 6-h PPI value was lower (p < 0.001) in the DEXA group (1.61 ± 0.21) than in the placebo group (2.66 ± 0.19). The total 6-h SF-MP score, especially the sensory domain, was higher (p = 0.054) in the placebo group (11.56 ± 0.75) than in the DEXA group (8.89 ± 0.75). Tramadol for epigastric pain relief was more frequent (p = 0.026) in the placebo group (44.4%) than in the DEXA group (11.1%). No differences were noted between groups in length of stay or complications, including acute or delayed bleeding. The distribution of artificial ulcer patterns at 48-h post-ESD as determined by second-look endoscopy was similar in both groups.
  
  
  CONCLUSIONS
  Single-dose perioperative intravenous dexamethasone after ESD effectively relieved epigastric pain 6 h postoperatively.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Lee
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Chung
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Young Chan
authors.initials: YC
authors.lastname: Lee
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone