The Effects of Single-Dose Preoperative Intravenous Dexamethasone on Clinical Outcome after Laparoscopic Cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy is one of the most common procedures in surgery. Post-operative pain and post- operative nausea and vomiting (PON) are frequently events after laparoscopic cholecystectomy and cause distress to patients. Dexamethasones are known for analgesic, anti-inflammatory, immune-modulating and anti-emetic effects. Therefore, preoperative dexamethasone administration may reduce postoperative pain and postoperative nausea vomiting after laparoscopic cholecystectomy.


OBJECTIVE
This study aims to determine the effects of single-dose preoperative intravenous dexamethasone on clinical outcome such as postoperative pain nausea and vomiting in patients undergoing laparoscopic cholecystectomy.


METHODS
This is a prospective randomized controlled trial study. Eighty patients undergoing elective laparoscopic cholecystectomy were randomized to dexamethasone group and control group. Dexamethasone group received 8 mg (2 ml) of intravenous dexamethasone 60-90 minute before surgery whereas control group received 2 ml of normal saline 60-90 minute before surgery. Patients received a similar standardized anesthesia, surgical and multimodal analgesic treatment. The pain score, nausea and vomiting at 1, 6, 24 hours after surgery and before discharge including analgesic consumption and antiemetic required was recorded in both groups. Preoperative and postoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured.


RESULTS
No significant difference existed between two groups regarding age, sex, previous operation, operation time and hospital stays. All of the patients had no postoperative complication. Postoperative pain score, nausea and vomiting at 1st and 6th hours in dexamethasone group were significantly reduced in comparison with control group. Analgesic consumption, antiemetic requirement and CRIP postoperative were significantly decreased in dexamethasone group.


CONCLUSIONS
Single-dose preoperative dexamethasone 8 mg 60-90 minute before induction of anesthesia improved clinical outcome in terms of significantly less nausea, vomiting, pain at first 6 hours and less inflammatory response after laparoscopic cholecystectomy compared to placebo. The preoperative dexamethasone should be used as routine in patients undergoing laparoscopic cholecystectomy.
Vichit
V
Viriyaroj
Thana
T
Boonsinsukh
Thammanij
T
Rookkachart
Narongchai
N
Yigsakmongkol
D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D000932:Antiemetics / Q000494:pharmacology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003907:Dexamethasone / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011300:Preoperative Care; D011446:Prospective Studies; D013785:Thailand
D000893:Anti-Inflammatory Agents; D000932:Antiemetics; D003907:Dexamethasone