SAN DIEGO – A single dose of dexamethasone given before outpatient laparoscopic cholecystectomy significantly improved measures of postoperative recovery and length of hospitalization, as well as quality of life after discharge, compared with placebo.
The findings of this randomized, double-blind study support previous studies suggesting that preoperative small-dose steroid therapy enhanced recovery, Dr. Glenn S. Murphy and his associates reported at the Annual Meeting of the American Society of Anesthesiologists.
The current study randomized patients undergoing elective laparoscopic cholecystectomy to receive either 8 mg dexamethasone or saline placebo 60 minutes before incision. All patients were expected to have same-day discharge, and all caregivers and patients were blinded to group assignment. The surgical procedures were standardized, as were fluid administration, ventilation, and anesthesia management using propofol, sevoflurane, rocuronium, fentanyl, and/or ondansetron.
The staff measured nausea, vomiting, pain, and fatigue preoperatively and at discharge from the postanesthesia care unit (PACU) and the ambulatory surgery unit (ASU). They recorded analgesic requirements during the hospitalization, and the length of time required to meet criteria for discharge from the PACU and ASU.
In addition, health status was assessed at baseline immediately prior to surgery using a previously validated 40-item scoring system, and patients took home another copy of this quality-of-recovery survey (QoR-40) to be completed 24 hours after discharge from the ASU.
Photo credit: (c)2010 American College of Surgeons/Elsevier
A single dose of dexamethasone given before outpatient laparoscopic cholecystectomy significantly improved measures of postoperative recovery and quality of life after discharge, compared with placebo, researchers report.
At baseline, the 56 patients in the dexamethasone group did not differ significantly from the 59 in the placebo group in terms of age, sex, height, weight, ASA physical status, history of smoking or drinking, hypertension, asthma, sleep apnea, or thyroid disease. Complete data were not available for five patients who were dropped from the analysis.
In the ASU, the dexamethasone group has less nausea, fatigue, and treatment of emetic symptoms, compared with the control group. In the PACU, the dexamethasone group had lower pain scores and less nausea, treatment of emetic symptoms, and need for analgesics. The dexamethasone patients had a 55 minute shorter stay in the ASU and were in the hospital 70 minutes less was than the control group, said Dr. Murphy of Northwestern University, Chicago.
The QoR-40 scores did not differ significantly between groups before surgery, but on postoperative day 1, the median global score in the control group was significantly lower (score of 161), compared with the dexamethasone group (score of 178), reflecting a worse quality of recovery in the control group, he said.
Three of the individual dimensions measured by the QoR-40 scored significantly lower in the control group, compared with the dexamethasone group postoperatively: emotional state (35 vs. 41), physical comfort (45 vs. 51), and pain (26 vs. 31). Scores for psychological support and physical independence did not differ significantly between groups.
Laparoscopic cholecystectomy is one of the most common elective surgical procedures in the United States, and up to 80% of patients may be discharged from the hospital on the day of surgery, data suggest. Investigators have looked to small-dose steroid therapy as a way to attenuate physiologic responses to minimally invasive surgery that can impair recovery and delay discharge, such as metabolic, hormonal, inflammatory, and immune responses activated by the surgery. Dexamethasone, a potent corticosteroid, has a biological half-life of 24-36 hours.
Dr. Murphy has been a consultant for Schering-Plough, which markets products containing dexamethasone.