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Quan ZF, Tian M, Chi P, Li X, He HL. Effective analgesic dose of dexamethasone after painless abortion. Int J Clin Exp Med 2014; 7:2144-2149. [PMID: 25232399 PMCID: PMC4161559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE Dexamethasone is known to produce analgesic effects, but the optimal analgesic dosage of dexamethasone remains unclear, especially in patients without postoperative use of other analgesics. The purpose of this study was to explore the effective analgesic dose of dexamethasone in day surgery patients undergoing painless abortion. METHODS 287 patients undergoing painless abortion were randomly assigned to one of four groups: control group receiving saline and dexamethasone groups receiving 0.1, 0.15, or 0.2 mg/kg dexamethasone. Drugs were intravenously injected 30 min before induction of anesthesia. All patients underwent the same anesthesia procedure using propofol and remifentan. The visual analogue scale (VAS) scores and occurrence of nausea, vomiting and drug-induced side effects were recorded at 1, 2 and 24 h after operation. RESULTS There were no significant differences in patient's clinical characteristics, surgical features and frequency of occurrence of nausea and vomiting among the four groups (P > 0.05). The VAS scores at rest and during coughing at 2 h after operation (time of discharge from the hospital) were significantly lower in patients receiving 0.2 mg/kg dexamethasone compared with control patients (P < 0.05). CONCLUSION Intravenous injection of 0.2 mg/kg dexamethasone before induction of anesthesia can significantly reduce the VAS scores at 2 h after painless abortion.
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Affiliation(s)
- Zhe-Feng Quan
- Department of Anesthesiology, Beijing You An Hospital, Capital Medical UniversityBeijing 100069, China
| | - Ming Tian
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical UniversityBeijing 100050, China
| | - Ping Chi
- Department of Anesthesiology, Beijing You An Hospital, Capital Medical UniversityBeijing 100069, China
| | - Xin Li
- Department of Anesthesiology, Beijing You An Hospital, Capital Medical UniversityBeijing 100069, China
| | - Hai-Li He
- Department of Anesthesiology, Beijing You An Hospital, Capital Medical UniversityBeijing 100069, China
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102
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Sridhar P, Sistla SC, Ali SM, Karthikeyan VS, Badhe AS, Ananthanarayanan PH. Effect of intravenous lignocaine on perioperative stress response and post-surgical ileus in elective open abdominal surgeries: a double-blind randomized controlled trial. ANZ J Surg 2014; 85:425-9. [DOI: 10.1111/ans.12783] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Parnandi Sridhar
- Department of Surgery; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Sarath Chandra Sistla
- Department of Surgery; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | - Sheik Manwar Ali
- Department of Surgery; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
| | | | - Ashok Shankar Badhe
- Department of Anesthesiology and Critical Care; Jawaharlal Institute of Postgraduate Medical Education and Research; Puducherry India
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The effect of single low-dose dexamethasone on blood glucose concentrations in the perioperative period: a randomized, placebo-controlled investigation in gynecologic surgical patients. Anesth Analg 2014; 118:1204-12. [PMID: 24299928 DOI: 10.1213/ane.0b013e3182a53981] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The effect of single low-dose dexamethasone therapy on perioperative blood glucose concentrations has not been well characterized. In this investigation, we examined the effect of 2 commonly used doses of dexamethasone (4 and 8 mg at induction of anesthesia) on blood glucose concentrations during the first 24 hours after administration. METHODS Two hundred women patients were randomized to 1 of 6 groups: Early-control (saline); Early-4 mg (4 mg dexamethasone); Early-8 mg (8 mg dexamethasone); Late-control (saline); Late-4 mg (4 mg dexamethasone); and Late-8 mg (8 mg dexamethasone). Blood glucose concentrations were measured at baseline and 1, 2, 3, and 4 hours after administration in the early groups and at baseline and 8 and 24 hours after administration in the late groups. The incidence of hyperglycemic events (the number of patients with at least 1 blood glucose concentration >180 mg/dL) was determined. RESULTS Blood glucose concentrations increased significantly over time in all control and dexamethasone groups (from median baselines of 94 to 102 mg/dL to maximum medians ranging from 141 to 161.5 mg/dL, all P < 0.001). Blood glucose concentrations did not differ significantly between the groups receiving dexamethasone (either 4 or 8 mg) and those receiving saline at any measurement time. The incidence of hyperglycemic events did not differ in any of the early (21%-28%, P = 0.807) or late (13%-24%, P = 0.552) groups. CONCLUSIONS Because blood glucose concentrations during the first 24 hours after administration of single low-dose dexamethasone did not differ from those observed after saline administrations, these results suggest clinicians need not avoid using dexamethasone for nausea and vomiting prophylaxis out of concerns related to hyperglycemia.
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104
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Gautam S, Agarwal A, Das PK, Agarwal A, Kumar S, Khuba S. Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial. Korean J Pain 2014; 27:278-84. [PMID: 25031815 PMCID: PMC4099242 DOI: 10.3344/kjp.2014.27.3.278] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/30/2022] Open
Abstract
Background Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. Results Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). Conclusions A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.
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Affiliation(s)
- Sujeet Gautam
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Amita Agarwal
- Dental Surgeon, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pravin Kumar Das
- Department of Anesthesiology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Anil Agarwal
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Kumar
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Khuba
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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105
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Rahimzadeh P, Imani F, Faiz SHR, Nikoubakht N, Sayarifard A. Effect of intravenous methylprednisolone on pain after intertrochanteric femoral fracture surgery. J Clin Diagn Res 2014; 8:GC01-4. [PMID: 24959459 DOI: 10.7860/jcdr/2014/8232.4305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/02/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pain after surgery is one of the major problems in patients with intertrochanteric fracture. This study investigates administration of single-dose Methylprednisolone prior to surgery with the goal of reducing Post-operative pain. MATERIALS AND METHODS The study was a Double Blind Randomized Clinical Trial. Eighty two patients with stable intertrochanteric unilateral fracture were selected and divided into two groups: one received Methylprednisolone (MP) 125 mg and the other received placebo. Pain was evaluated at rest and 45° flexion of the hip in times 4, 6, 8, 12, 24, 36, and 48 hours and during walking in times 24, 36, and 48 hours after the surgery. Post-operative nausea, vomiting and fatigue and changes in C - reactive protein (CRP) levels before and after the surgery were also recorded. RESULTS Pain at rest, 45° flexion of the hip and during walking after the surgery was significantly lower in the MP group compared to the control group (p < 0.001). Fatigue (p = 0.002) and changes in CRP (p=0.001) were significantly lower in MP group. Incidence of nausea, vomiting (p = 0.37) and opioid consumption (p = 0.49) were not significantly different between the two groups. CONCLUSION Single-dose methylprednisolone 125 mg (IV) can reduce Post-operative pain in patients with intertrochanteric fracture undergoing elective surgery.
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Affiliation(s)
- Poupak Rahimzadeh
- Assistant Professor, Anesthesiologist, Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center , Iran. University of Medical Sciences Tehran, Iran
| | - Farnad Imani
- Anesthesiologist, Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center , Iran. University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Anesthesiologist, Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center , Iran. University of Medical Sciences, Tehran, Iran
| | - Nasim Nikoubakht
- Resident of Anesthesiology, Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center , Iran. University of Medical Sciences, Tehran, Iran
| | - Azadeh Sayarifard
- Assistant Professor, Preventive and Community Medicine Specialist, Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors , Tehran University of Medical Sciences, Tehran, Iran
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106
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Jørgensen LN, Rosenberg J, Al-Tayar H, Assaadzadeh S, Helgstrand F, Bisgaard T. Randomized clinical trial of single- versus multi-incision laparoscopic cholecystectomy. Br J Surg 2014; 101:347-55. [PMID: 24536008 DOI: 10.1002/bjs.9393] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND There are no randomized studies that compare outcomes after single-incision (SLC) and conventional multi-incision (MLC) laparoscopic cholecystectomy under an optimized perioperative analgesic regimen. METHODS This patient- and assessor-blinded randomized three-centre clinical trial compared SLC and MLC in women admitted electively with cholecystolithiasis. Outcomes were registered on the day of operation (day 0), on postoperative days 1, 2, 3 and 30, and 12 months after surgery. Blinding of the patients was maintained until day 3. The primary endpoint was pain on movement measured on a visual analogue scale, reported repeatedly by the patient until day 3. RESULTS The intention-to-treat population comprised 59 patients in the SLC and 58 in the MLC group. There was no significant difference between the groups with regard to any of the pain-related outcomes, on-demand administration of opioids or general discomfort. Median duration of surgery was 32·5 min longer in the SLC group (P < 0·001). SLC was associated with a reduced incidence of vomiting on day 0 (7 versus 22 per cent; P = 0·019). The incidences of wound-related problems were comparable. One patient in the SLC group experienced a biliary leak requiring endoscopic retrograde cholangiopancreatography. The rates of incisional hernia at 12-month follow-up were 2 per cent in both groups. Cosmetic rating was significantly improved after SLC at 1 and 12 months (P < 0·001). CONCLUSION SLC did not significantly diminish early pain in a setting with optimized perioperative analgesic patient care. SLC may reduce postoperative vomiting. REGISTRATION NUMBER NCT01268748 (http://www.clinicaltrials.gov).
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Affiliation(s)
- L N Jørgensen
- Departments of Surgery, Bispebjerg Hospital, Copenhagen
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107
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Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp 2014; 72:1-12. [PMID: 24648571 DOI: 10.1016/j.curtheres.2011.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) are potential complications in patients after laparoscopic cholecystectomy (LC). Combination antiemetic therapy often is effective for preventing PONV in patients undergoing LC, and combinations of antiemetics targeting different sites of activity may be more effective than monotherapy. OBJECTIVE The aim of this study was to compare the administration of a subhypnotic dose of propofol combined with dexamethasone with one of propofol combined with metoclopramide to prevent PONV after LC. METHODS Sixty adult patients scheduled for LC were randomly assigned to 1 of 2 treatment groups. The patients in group 1 received 0.5 mg/kg propofol plus 8 mg dexamethasone, and those in group 2 received 0.5 mg/kg propofol plus 0.2 mg/kg metoclopramide. The number of patients experiencing nausea and vomiting at 0 to 4, 4 to 12, and 12 to 24 hours postoperatively and as well as additional use of rescue antiemetics were recorded. RESULTS The total PONV rates up to 24 hours postanesthesia were 23.3% and 50% for group 1 and group 2, respectively. Comparisons of the data revealed that at 0 to 4 hours, the number of patients experiencing vomiting was 6 (20%) in group 1 and14 (46.7%) in group 2 (P = 0.028). The frequency of vomiting in group 1 was significantly lower than that for group 2 (P = 0.028), and the rate of rescue antiemetic use in group 2 was higher than that in group 1 (20% vs 46.7%; P = 0.028). In the evaluation of PONV based on the nausea and vomiting scale scores, the mean PONV score was 0.4 (0.2) in group 1 compared with 1.0 (0.2) in group 2 (P = 0.017). There were no significant differences between the values at 4 to 12 hours and at 12 to 24 hours. The frequency of adverse reactions (respiratory depression: 1.3%, 1.3%; laryngospasm: 1.3%, 0%; cough: 1.3%, 0%; hiccup: 1.3%, 0%;) was not significantly different in the 2 groups. CONCLUSIONS Administration of a subhypnotic dose of 0.5 mg/kg propofol plus 8 mg dexamethasone at the end of surgery was more effective than administration of 0.5 mg/kg propofol plus metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing LC.
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108
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Demirhan A, Tekelioglu UY, Akkaya A, Bilgi M, Apuhan T, Karabekmez FE, Bayir H, Kurt AD, Kocoglu H. Effect of pregabalin and dexamethasone addition to multimodal analgesia on postoperative analgesia following rhinoplasty surgery. Aesthetic Plast Surg 2013; 37:1100-6. [PMID: 24057811 DOI: 10.1007/s00266-013-0207-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND We investigated the effect of a combination of pregabalin and dexamethasone, when used as part of a multimodal analgesic regimen, on pain control after rhinoplasty operations. METHODS Sixty patients were enrolled in this study. They were randomly assigned into three groups: Group C (placebo + placebo), Group P (pregabalin + placebo), and Group PD (pregabalin + dexamethasone). Patients received either pregabalin 300 mg orally 1 h before surgery, dexamethasone 8 mg intravenously during induction, or placebo according to their allocation. Postoperative pain was treated with intravenous patient-controlled analgesia (tramadol, 20-mg bolus dose, 45-min lockout time). The numeric rating scale (NRS), side effects, and consumption of tramadol, pethidine, and ondansetron were assessed. RESULTS The median NRS scores at 0, 1, and 6 h after surgery were significantly higher in Group C than in Group PD (p < 0.001 for all). The 24-h consumption of tramadol and pethidine was significantly reduced in Groups P and PD compared to Group C (p < 0.01 and p < 0.01). The total tramadol consumption was decreased by 54.5 % in Group P and 81.9 % in Group PD compared to Group C (p < 0.001 for both). The incidence of nausea was higher in Group C than in Groups P and PD between the postoperative 0-2 and 0-24-h periods (p < 0.05 for both). The frequency of blurred vision was significantly higher in Groups P and PD than in Group C within the 0-24-h period (p < 0.05 for both). CONCLUSION We found that the addition of a single dose of pregabalin and dexamethasone to multimodal analgesia in rhinoplasty surgeries provided efficient analgesia and thus decreased opioid consumption. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abdullah Demirhan
- Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Golkoy, 14280, Bolu, Turkey,
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Faiz SHR, Rahimzadeh P, Alebouyeh MR, Sedaghat M. A Randomized Controlled Trial on Analgesic Effects of Intravenous Acetaminophen versus Dexamethasone after Pediatric Tonsillectomy. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e9267. [PMID: 24719693 PMCID: PMC3971785 DOI: 10.5812/ircmj.9267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/02/2013] [Accepted: 05/19/2013] [Indexed: 11/22/2022]
Abstract
Background A few studies are available actually comparing the clinical efficacy of intravenous acetaminophen with other medications such as dexamethasone to inhibit postoperative adverse events in children. Objectives This randomized blinded controlled trial was designed to compare controlling status of postoperative events in children after tonsillectomy randomized to receive either intravenous acetaminophen or dexamethasone. Patients and Methods Eighty four children aged between 4 to 13 undergoing tonsillectomy were randomized using a computer-generated schedule to double-blind treatment with intravenous acetaminophen (15 mg/kg) or intravenous dexamethasone (0.1 mg/kg). Children were post-operatively assessed for swallowing pain, pain while opening mouth, ear pain, and postoperative sore throat in recovery room (within one hour after surgery), at the time of admission to the ward, as well as at 12 and 24 hours after surgery, assessed by the objective pain scoring system (OPS; minimum score: 0 = no pain, maximum score: 10 = extreme pain). Results There were no significant differences between the two groups with regard to the severity of postoperative pain due to swallowing or opening mouth measured at the different study time points from postoperative recovery to 24 hours after the surgery. There was no difference in ear pain severity at the time of postoperative recovery, at the admission time to ward and also at 12 hours after surgery; however mean score of ear pain severity was significantly higher in those who administered acetaminophen 24 hours after operation. Also, the mean score severity of sore throat was significantly higher in the acetaminophen compared with the dexamethasone group within 12 hours of surgery. Postoperative vomiting and bleeding were similarly observed between the two study groups. The severity of swallowing pain, pain while opening mouth, ear pain, as well as postoperative sore throat as gradually assuaged within 24 hours of tonsillectomy in both groups, however no between-group differences were observed in the trend of the severity of these events. Conclusions The dexamethasone-based regimen may have more advantage over the intravenous acetaminophen regimen for inhibiting pain and PONV following tonsillectomy in children.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
- Corresponding Author: Poupak Rahimzadeh, Rasoul-Akram Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/fax: +98-2166509059, E-mail: ;
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Minow Sedaghat
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
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Ju NY, Cui GX, Gao W. Ropivacaine plus dexamethasone infiltration reduces postoperative pain after tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol 2013; 77:1881-5. [PMID: 24060088 DOI: 10.1016/j.ijporl.2013.08.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the effect of ropivacaine plus dexamethasone and ropivacaine alone as infiltration anesthesia on postoperative pain, nausea and vomiting, and oral intake in children after tonsillectomy and adenoidectomy. METHODS Two hundred pediatric patients scheduled for tonsillectomy and adenoidectomy were prospectively enrolled and randomly placed in a ropivacaine with dexamethasone group (RD) or a ropivacaine alone group (R). Treatment for both groups was administered by local infiltration, and pain scores were recorded at various intervals. Primary outcomes were pain scores recorded 4-24h postoperation. Secondary outcomes included time to the first administration of analgesic and total consumption of analgesics for all children, time to first water request, first oral intake, incidence of nausea or vomiting, and time to discharge. RESULTS From postoperative hours 4-24, children in the RD group had lower pain scores than children in the R group (P < 0.05). Total fentanyl consumption was significantly decreased in the RD group compared to the R group (50.9 ± 9.3 vs. 103.9 ± 11.5 μg, P < 0.001). The time to first water request and first oral intake were significantly shorter in the RD group [(40 min (27-64) vs. 64 min (43-89); P < 0.001) and (54 min (40-91) vs. 85 min (67-127); P < 0.001), respectively]. Oral intake was significantly improved, and the incidence of nausea and vomiting were reduced in the RD group (P < 0.05). The time to discharge was shorter in the RD group when compared with the R group (9.06 ± 0.89 d vs. 7.05 ± 0.71 d; P < 0.001). CONCLUSIONS Ropivacaine plus dexamethasone infiltration effectively lowers pain, improves oral intake, lowers postoperative nausea and vomiting, and decreases the time to discharge.
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Affiliation(s)
- Nan Ying Ju
- ICU Department, The Third Affiliated Hospital of Harbin Medical University, 150 Haping Road, Nangang District of Harbin, China
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112
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Abdelmalak B, Bonilla A, Mascha E, Maheshwari A, Wilson Tang W, You J, Ramachandran M, Kirkova Y, Clair D, Walsh R, Kurz A, Sessler D. Dexamethasone, light anaesthesia, and tight glucose control (DeLiT) randomized controlled trial. Br J Anaesth 2013; 111:209-221. [DOI: 10.1093/bja/aet050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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113
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Galinski SF, Pereira JA, Maestre Y, Francés S, Escolano F, Puig MM. The combination of intravenous dexamethasone and ketamine does not improve postoperative analgesia when compared to each drug individually. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/016911107x376936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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114
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Bernardo WM, Aires FT. Efficacy of dexamethasone in the prophylaxis of nausea and vomiting during the postoperative period of laparoscopic cholecystectomy. Rev Assoc Med Bras (1992) 2013; 59:387-91. [PMID: 23866937 DOI: 10.1016/j.ramb.2013.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/02/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To verify the efficacy of dexamethasone in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy. METHODS This was a systematic review of the literature through the MEDLINE, Embase, and LILACS databases. Only controlled and randomized clinical trials comparing dexamethasone to placebo in the prophylaxis of nausea and vomiting in patients submitted to laparoscopic cholecystectomy were included. RESULTS The results of this review were based on data from 12 controlled and randomized clinical trials, totaling 947 patients. The group of patients who received preoperative dexamethasone showed lower incidence of nausea (number needed to treat [NNT]=7), vomiting (NNT=7), and need for smaller doses of rescue antiemetics (NNT=6). CONCLUSION The preoperative infusion of 8 mg of dexamethasone decreases the risk of complications in the postoperative period for patients submitted to laparoscopic cholecystectomy.
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115
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Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. J Res Pharm Pract 2013; 2:99-104. [PMID: 24991614 PMCID: PMC4076920 DOI: 10.4103/2279-042x.122370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Any operation leads to body stress and tissue injury that causes pain and its complications. Glucocorticoids such as Dexamethasone are strong anti-inflammatory agents, which can be used for a short time post-operative pain control in various surgeries. Main purpose of this study is to evaluate the effect of administration of intravenous (IV) Dexamethasone on reducing the pain after cesarean. METHODS A double-blind prospective randomized clinical trial was performed on 60 patients candidate for elective caesarean section. Patients were randomly assigned into two groups: A (treatment: 8 mg IV Dexamethasone) and B (control: 2 mL normal saline). In both groups, variables such as mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), pain and vomiting severity (based on visual analog scale) were recorded in different time points during first 24 h after operation. Statistical methods using repeated measure analysis of variances and t-test, Mann-Whitney and Chi-square tests were used for analyzing data. FINDINGS The results indicated that within-group comparisons including severity of pain, MAP, RR and HR have significant differences (P < 0.001 for all variables) during the study period. Between group comparisons indicated significant differences in terms of pain severity (P < 0.001), MAP (P = 0.048) and HR (P = 0.078; marginally significant), which in case group were lower than the control group. CONCLUSION IV Dexamethasone could efficiently reduce post-operative pain severity and the need for analgesic consumption and improve vital signs after cesarean section.
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Affiliation(s)
- Azar Danesh Shahraki
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan
| | - Awat Feizi
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan
| | - Mitra Jabalameli
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan
| | - Shadi Nouri
- School of Medicine, Isfahan University of Medical Sciences, Isfahan
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Simsa J, Magnusson N, Hedberg M, Lorentz T, Gunnarsson U, Sandblom G. Betamethasone in hernia surgery: a randomized controlled trial. Eur J Pain 2013; 17:1511-6. [PMID: 23712446 DOI: 10.1002/j.1532-2149.2013.00333.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Post-operative pain and nausea may be a problem in day-case surgery. This study aims to investigate the effect of betamethasone on pain and nausea in inguinal hernia surgery. METHODS Patients aged 18-70 years scheduled for open inguinal hernia surgery at two Swedish hospitals, March 2005-December 2009, were eligible for inclusion. Patients were randomized, to either treatment with 12 mg betamethasone intravenously or placebo. Post-operative pain was assessed using a visual analogue scale on the recovery ward, each day the first post-operative week and at 1 month after surgery. One year after surgery, residual pain was estimated by the Inguinal Pain Questionnaire. RESULTS A total of 398 patients were included (21 women, 377 men). Pain at rest on the day of surgery was significantly lower in the treatment group (p = 0.012). The pain was also significantly lower in the treatment group the day after surgery (p < 0.001), but not during the remaining part of the first post-operative week. Bleeding complications were reported by 17 patients (8.5%) in the Betamethasone group and seven (3.5%) in the placebo group (p = 0.028). One month after surgery, 21 out of 173 (12%) in the betamethasone group still had pain, compared to 33 out of 159 (21%) in the placebo arm (p = 0.049). After 1 year, no significant difference in pain was seen. CONCLUSION A 12 mg betamethasone reduced pain during the first 24 h and at 1 month after inguinal hernia surgery. If combined with diclofenac, however, this dose may increase the risk for bleeding complications.
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Affiliation(s)
- J Simsa
- Department of Anesthesiology, Ludvika Hospital, Sweden
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Rosenmüller MH, Thorén Örnberg M, Myrnäs T, Lundberg O, Nilsson E, Haapamäki MM. Expertise-based randomized clinical trial of laparoscopic versus small-incision open cholecystectomy. Br J Surg 2013; 100:886-94. [DOI: 10.1002/bjs.9133] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 01/12/2023]
Abstract
Abstract
Background
Several randomized clinical trials have compared laparoscopic cholecystectomy (LC) and small-incision open cholecystectomy (SIOC). Most have had wide exclusion criteria and none was expertise-based. The aim of this expertise-based randomized trial was to compare healthcare costs, quality of life (QoL), pain and clinical outcomes after LC and SIOC.
Methods
Patients scheduled for cholecystectomy were randomized to treatment by one of two teams of surgeons with a preference for either LC or SIOC. Each team performed their specific method (SIOC or LC) as a first-choice operation, but converted to open cholecystectomy and common bile duct exploration when necessary. Intraoperative cholangiography was carried out routinely. The intention was to include all patients undergoing cholecystectomy, including emergency operations and procedures involving surgical training for residents.
Results
Some 74·9 per cent of all patients undergoing cholecystectomy were included. Of 355 patients randomized, 333 were analysed. Self-estimated QoL scores in 258 patients, analysed by the area under the curve method, were significantly lower in the SIOC group at 1 month after surgery: median 2326 (95 per cent confidence interval 2187 to 2391) compared with 2411 (2334 to 2502) for the LC group (P = 0·030). The mean(s.d.) duration of operation was shorter for SIOC: 97(41) versus 120(48) min (P < 0·001). There were no significant differences between the groups in conversion rate, pain, complications, length of hospital stay or readmissions.
Conclusion
SIOC had comparable surgical results but slightly worse short-term QoL compared with LC. Registration number: NCT00370344 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M H Rosenmüller
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | | | - T Myrnäs
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - O Lundberg
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - E Nilsson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - M M Haapamäki
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
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Abdelmalak BB, Bonilla AM, Yang D, Chowdary HT, Gottlieb A, Lyden SP, Sessler DI. The Hyperglycemic Response to Major Noncardiac Surgery and the Added Effect of Steroid Administration in Patients With and Without Diabetes. Anesth Analg 2013; 116:1116-1122. [DOI: 10.1213/ane.0b013e318288416d] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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119
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Effect of dexamethasone on prevention of postoperative nausea, vomiting and pain after caesarean section. Eur J Anaesthesiol 2013; 30:102-5. [DOI: 10.1097/eja.0b013e328356676b] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rehman H, Mathews T, Ahmed I. A review of minimally invasive single-port/incision laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A 2013; 22:641-6. [PMID: 22954028 DOI: 10.1089/lap.2011.0237] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Single-port/incision laparoscopic appendectomy (SPILA) is a modern advancement toward stealth surgery, using a single point of entry. Despite the paucity of clinical data, it is increasingly being used to minimize scarring and, potentially, pain associated with the multiple entry points. We aimed to summarize and present available data on this new approach. METHODOLOGY All available databases until December 2010 including the Cochrane Controlled Trials Register, MEDLINE, and EMBASE were searched and cross-referenced for studies describing single-incision laparoscopic appendectomy. Case and experimental reports, series with fewer than 5 patients, and non-English articles were excluded. Outcome measures were operative time, postoperative hospital stay, pain scores, complications, conversion, and mortality, stratified according to type of SPILA approach. SPSS version 18.0.0 software was used for data collection. RESULTS Database query yielded 79 articles; 45 were included (1 randomized controlled trial, 44 case series). Total cases were 2806, with mean patient age for studies ranging from 7.0 to 37.5 years. No mortality was reported. The overall complication rate was 4.13%. The overall weighted mean operating time was 41.3 minutes (range, 15.0-95.9 minutes). The weighted mean hospital stay was 2.79 days (range, 1.0-6.6 days). CONCLUSIONS Although the incidence of complications with SPILA remains low and operating times between new and traditional approaches are comparable in case-based literature, adequately powered randomized trials are required to assess its effectiveness. Occurrence of long-term complication types remains unexplored.
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Affiliation(s)
- Haroon Rehman
- University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Combination of Pregabalin and Dexamethasone for Postoperative Pain and Functional Outcome in Patients Undergoing Lumbar Spinal Surgery. Clin J Pain 2013; 29:9-14. [DOI: 10.1097/ajp.0b013e318246d1a9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dar F, Jan N, Najar M. Effect of addition of dexamethasone to ropivacaine in supraclavicular brachial plexus block. INDIAN JOURNAL OF PAIN 2013. [DOI: 10.4103/0970-5333.124602] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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De Oliveira GS, Castro-Alves LJS, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg 2012; 116:58-74. [PMID: 23223115 DOI: 10.1213/ane.0b013e31826f0a0a] [Citation(s) in RCA: 217] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dexamethasone has an established role in decreasing postoperative nausea and vomiting (PONV); however, the optimal dexamethasone dose for reducing PONV when it is used as a single or combination prophylactic strategy has not been clearly defined. In this study, we evaluated the use of 4 mg to 5 mg and 8 mg to 10 mg IV doses of dexamethasone to prevent PONV when used as a single drug or as part of a combination preventive therapy. METHODS A wide search was performed to identify randomized clinical trials that evaluated systemic dexamethasone as a prophylactic drug to reduce postoperative nausea and/or vomiting. The effects of dexamethasone dose were evaluated by pooling studies into 2 groups: 4 mg to 5 mg and 8 mg to 10 mg. The first group represents the suggested dexamethasone dose to prevent PONV by the Society for Ambulatory Anesthesia (SAMBA) guidelines, and the second group represents twice the dose range recommended by the guidelines. The SAMBA guidelines were developed in response to studies, which have been performed to examine different dosages of dexamethasone. RESULTS Sixty randomized clinical trials with 6696 subjects were included. The 4-mg to 5-mg dose dexamethasone group experienced reduced 24-hour PONV compared with control, odds ratio (OR, 0.31; 95% confidence interval [CI], 0.23-0.41), and number needed to treat (NNT, 3.7; 95% CI, 3.0-4.7). When used together with a second antiemetic, the 4-mg to 5-mg dexamethasone group also experienced reduced 24-hour PONV compared with control (OR, 0.50; 95% CI, 0.35-0.72; NNT, 6.6; 95% CI, 4.3-12.8). The 8-mg to 10-mg dose dexamethasone group experienced decreased 24-hour PONV compared with control (OR, 0.26; 95% CI, 0.20-0.32; NNT, 3.8; 95% CI, 3.0-4.3). Asymmetric funnel plots were observed in the 8-mg to 10-mg dose analysis, suggesting the possibility of publication bias. When used together with a second antiemetic, the 8-mg to 10-mg dose group also experienced reduced incidence of 24-hour PONV (OR, 0.35; 95% CI, 0.22-0.53; NNT, 6.2; 95% CI, 4.5-10). In studies that provided a direct comparison between groups, there was no clinical advantage of the 8-mg to 10-mg dexamethasone dose compared with the 4-mg to 5-mg dose on the incidence of postoperative nausea and/or vomiting. CONCLUSIONS Our results showed that a 4-mg to 5-mg dose of dexamethasone seems to have similar clinical effects in the reduction of PONV as the 8-mg to 10-mg dose when dexamethasone was used as a single drug or as a combination therapy. These findings support the current recommendation of the SAMBA guidelines for PONV, which favors the 4-mg to 5-mg dose regimen of systemic dexamethasone.
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Affiliation(s)
- Gildasio S De Oliveira
- MSCI, Department of Anesthesiology, Northwestern Memorial Hospital, 251 E Huron St, F5-704, Chicago, IL 60611, USA.
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Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2012; 110:191-200. [PMID: 23220857 DOI: 10.1093/bja/aes431] [Citation(s) in RCA: 408] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The analgesic efficacy and adverse effects of a single perioperative dose of dexamethasone are unclear. We performed a systematic review to evaluate the impact of a single i.v. dose of dexamethasone on postoperative pain and explore adverse events associated with this treatment. METHODS MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for randomized, controlled studies that compared dexamethasone vs placebo or an antiemetic in adult patients undergoing general anaesthesia and reported pain outcomes. RESULTS Forty-five studies involving 5796 patients receiving dexamethasone 1.25-20 mg were included. Patients receiving dexamethasone had lower pain scores at 2 h {mean difference (MD) -0.49 [95% confidence interval (CI): -0.83, -0.15]} and 24 h [MD -0.48 (95% CI: -0.62, -0.35)] after surgery. Dexamethasone-treated patients used less opioids at 2 h [MD -0.87 mg morphine equivalents (95% CI: -1.40 to -0.33)] and 24 h [MD -2.33 mg morphine equivalents (95% CI: -4.39, -0.26)], required less rescue analgesia for intolerable pain [relative risk 0.80 (95% CI: 0.69, 0.93)], had longer time to first dose of analgesic [MD 12.06 min (95% CI: 0.80, 23.32)], and shorter stays in the post-anaesthesia care unit [MD -5.32 min (95% CI: -10.49 to -0.15)]. There was no dose-response with regard to the opioid-sparing effect. There was no increase in infection or delayed wound healing with dexamethasone, but blood glucose levels were higher at 24 h [MD 0.39 mmol litre(-1) (95% CI: 0.04, 0.74)]. CONCLUSIONS A single i.v. perioperative dose of dexamethasone had small but statistically significant analgesic benefits.
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Affiliation(s)
- N H Waldron
- Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA
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Grady MV, Mascha E, Sessler DI, Kurz A. The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy. Anesth Analg 2012; 115:1078-84. [PMID: 23011561 DOI: 10.1213/ane.0b013e3182662e01] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning. METHODS Women having open hysterectomy were anesthetized with sevoflurane, followed by patient-controlled morphine. Patients were factorially randomized to one of the following groups: (1) lidocaine and placebo, (2) placebo and ketamine, (3) placebo and placebo, or (4) lidocaine and ketamine. Lidocaine was given as a bolus (1.5 mg/kg), followed by lidocaine infusion of 2 mg/kg/h for the first 2 hours, and then 1.2 mg/kg/h for 24 postoperative hours. Ketamine was given as a bolus (0.35 mg/kg), followed by ketamine infusion of 0.2 mg/kg/h for the first 2 hours, and then 0.12 mg/kg/h for 24 postoperative hours. The primary double-blind outcome was 6-MWD on the second postoperative morning; secondary outcomes included pain scores, opioid consumption, postoperative nausea and vomiting, and fatigue score. RESULTS The study was stopped after a planned interim analysis of 64 patients showed that lidocaine crossed the preplanned futility boundary, with mean ± SD of 202 ± 66 m versus 202 ± 73 m for lidocaine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of 0.93 m (-52, 54) (P = 0.96); the ketamine effect also crossed the futility boundary, with mean ± SD of 193 ± 77 m versus 210 ± 61 m for ketamine versus placebo, respectively, and mean difference (interim adjusted 97.5% confidence interval) of -11 m (-65, 44) (P = 0.54). No interaction between the 2 intervention effects was observed (P = 0.96). Neither intervention significantly influenced any of the secondary outcomes. CONCLUSION Our results do not support use of lidocaine or ketamine for improving 6-MWD on the second postoperative day after open hysterectomy.
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Affiliation(s)
- Martin V Grady
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH 44195, USA
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Hessami MA, Yari M. Granisetron versus dexamethasone in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy. Anesth Pain Med 2012; 2:81-4. [PMID: 24223343 PMCID: PMC3821123 DOI: 10.5812/aapm.6945] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 07/10/2012] [Accepted: 07/26/2012] [Indexed: 12/01/2022] Open
Abstract
Background Post-operative nausea and vomiting (PONV) is one of the common problems after laparoscopic cholecystectomy. Objectives The current study aimed to compare Dexamethasone effect with that of Granisetron in prevention of PONV. Patients and Methods In the current study 104 patients aged 20-60 with ASA class I or II who were candidates for laparoscopic cholecystectomy were included in the study. Patients were randomly divided into two groups of A and B. 15 minutes before anesthesia induction, in group a patient’s 3 mg Granisetron and in group B patients 8 mg Dexamethasone was intravenously injected. Then both groups underwent general anesthesia with similar medications. After operation the prevalence of nausea and vomiting was assessed at three time intervals (0-6 hours, 6-12 hours and 12-24 hours after consciousness). SPSS software version 16 was employed to analyze data. T test, chi-square test and Fischer exact test were performed level of significance was P < 0.05. Results There was no significant difference between age, gender proportion, weight, height, and body mass index (BMI) of patients in the two groups. In Dexamethasone group, seven patients experienced nausea and three patients had vomiting, and in Granisetron group, five patients experienced nausea and three patients had vomiting after consciousness. Statistical analysis indicated no significant difference between the two groups in this regard. Conclusions Intravenous injection of 8 mg Dexamethasone or 3 mg Granisetron before anesthesia induction had similar effects in prophylaxis of nausea and vomiting after laparoscopic cholecystectomy.
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Affiliation(s)
- Mohammad Ali Hessami
- Department of Surgery, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Mitra Yari
- Clinical Research Development Center, Imam Reza Hospital, Department of Anesthesiology, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding author: Mitra Yari, Department of Anesthesiology, Kermanshah University of Medical Sciences, Imam Reza Hospital, Parastar Blvd., Kermanshah, IR Iran. Tel.: +98-9181314380, Fax: +98-8314276310, E-mail:
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Granisetron Versus Dexamethasone in Prophylaxis of Nausea and Vomiting After Laparoscopic Cholecystectomy. Anesth Pain Med 2012. [DOI: 10.5812/anesthpain.6945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen CC, Siddiqui FJ, Chen TL, Chan ESY, Tam KW. Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials. World J Surg 2012; 36:61-8. [PMID: 22083435 DOI: 10.1007/s00268-011-1343-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes. METHODS We conducted a systematic review of randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence of PONV within 24 h, and the secondary outcomes were pain, use of analgesics, and steroid-related complications. RESULTS Five RCTs were included with a total of 497 patients. A statistically and clinically significant difference in the incidence of PONV was found in favor of dexamethasone [relative risk (RR) 0.38; 95% confidence interval (CI) 0.30-0.49). The visual analog pain score was significantly diminished (weighted mean difference, WMD)-1.50; 95% CI-2.54 to -0.46) at 24 h. The incidence of analgesics use was also reduced (RR 0.61; 95% CI 0.41-0.90) in the dexamethasone group. No steroid-related complications were noted. CONCLUSIONS A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.
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Affiliation(s)
- Chia-Che Chen
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 11031, Taiwan
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Song YK, Lee C. Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery. J Anesth 2012; 27:29-34. [PMID: 22965329 DOI: 10.1007/s00540-012-1473-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 08/14/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Some antiemetics are effective in the treatment of postoperative pain and shivering, as well as for postoperative nausea and vomiting (PONV). The aim of this study was to investigate the effects of ramosetron and dexamethasone on PONV, pain, and shivering and to determine the correlations between nausea, pain, and shivering. METHODS For this study, 123 patients scheduled for thyroid surgery were randomly allocated to one of three groups: the control group (group C, n = 41), dexamethasone group (group D, n = 41), or the ramosetron group (group R, n = 41). The patients were treated intravenously with 2 mL of 0.9 % NaCl, 2 mL of 5 mg/mL dexamethasone, or 2 mL of 0.15 mg/mL ramosetron immediately after anesthesia. RESULTS The overall incidence and severity of postoperative nausea and the level of antiemetic consumption were significantly lower in group R compared with group D, and these parameters were significantly lower in groups R and D than in group C. There were significant differences in the incidence and severity of shivering, severity of pain, and analgesic consumption between group C and group R or D, but the incidence of shivering, pain severity, and analgesic consumption did not differ between groups R and D. The severity of shivering was significantly lower in group R than in group D. The correlation coefficients for shivering and pain, shivering and nausea, and pain and nausea were 0.210 (P = 0.010), 0.106 (P = 0.198), and 0.190 (P = 0.035), respectively, in group C. CONCLUSIONS Two antiemetic drugs, ramosetron and dexamethasone, significantly reduced the incidence and severity of postoperative nausea and the need for administration of rescue antiemetic drugs. Furthermore, both drugs effectively decreased the severity of pain and shivering. Ramosetron was superior to dexamethasone for reducing nausea, antiemetic consumption, and the severity of nausea, but not for reducing the incidence of shivering. Further studies are required to elucidate the correlations between postoperative nausea, pain, and shivering, as a statistically significant but weak correlation was shown in the present study.
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Affiliation(s)
- Yoon-Kang Song
- Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, 344-2 Sinyong-dong, Iksan, 570-711, Korea.
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Tolver MA, Strandfelt P, Bryld EB, Rosenberg J, Bisgaard T. Randomized clinical trial of dexamethasone versus placebo in laparoscopic inguinal hernia repair. Br J Surg 2012; 99:1374-80. [DOI: 10.1002/bjs.8876] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The effect of dexamethasone on recovery and length of convalescence has not been evaluated in patients after laparoscopic groin hernia repair. It was hypothesized that preoperative intravenous dexamethasone would reduce postoperative pain.
Methods
Men undergoing transabdominal preperitoneal (TAPP) inguinal hernia repair were randomized to receive either a single intravenous dose of 8 mg dexamethasone or placebo (saline) 30–60 min before operation in a randomized double-blind trial. Patients in the two groups received similar standardized anaesthesia and analgesic regimens. The primary outcome measure was pain during coughing on postoperative day 1. Secondary outcomes were postoperative discomfort, fatigue and length of convalescence. Pain scores, discomfort and fatigue were recorded before surgery and daily on postoperative days 0–3 in a standard manner using visual analogue, verbal rating and numerical rating scales. The use of analgesics and antiemetics on the day of operation was recorded. The duration of time away from work and leisure activities was registered.
Results
The study enrolled 80 patients. No significant differences were found between the groups regarding postoperative pain, need for analgesia, discomfort, fatigue, nausea, vomiting or length of convalescence. Patients who received placebo used significantly more antiemetics in the postanaesthesia care unit (PACU) than patients in the dexamethasone group (P = 0·026).
Conclusion
A single preoperative dose of 8 mg dexamethasone before laparoscopic groin hernia repair had no clinical effect on early postoperative pain, discomfort or fatigue after TAPP inguinal hernia repair, but resulted in a significantly lower use of antiemetics in the PACU. Registration number: NCT01170780 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M A Tolver
- Department of Surgery, Køge Hospital, University of Copenhagen, Køge, Herlev, Denmark
| | - P Strandfelt
- Department of Surgery, Køge Hospital, University of Copenhagen, Køge, Herlev, Denmark
| | - E B Bryld
- Department of Anaesthesiology, Køge Hospital, University of Copenhagen, Køge, Herlev, Denmark
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - T Bisgaard
- Department of Surgery, Køge Hospital, University of Copenhagen, Køge, Herlev, Denmark
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Petersen PL, Stjernholm P, Kristiansen VB, Torup H, Hansen EG, Mitchell AU, Moeller A, Rosenberg J, Dahl JB, Mathiesen O. The beneficial effect of transversus abdominis plane block after laparoscopic cholecystectomy in day-case surgery: a randomized clinical trial. Anesth Analg 2012; 115:527-33. [PMID: 22763903 DOI: 10.1213/ane.0b013e318261f16e] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is associated with postoperative pain of moderate intensity in the early postoperative period. Recent randomized trials have demonstrated the efficacy of transversus abdominis plane (TAP) block in providing postoperative analgesia after abdominal surgery. We hypothesized that a TAP block may reduce pain while coughing and at rest for the first 24 postoperative hours, opioid consumption, and opioid side effects in patients undergoing laparoscopic cholecystectomy in day-case surgery. METHODS In this randomized, double-blind study, 80 patients undergoing laparoscopic cholecystectomy in our day-case surgery unit were allocated to receive either bilateral ultrasound-guided posterior TAP blocks (20 mL 0.5% ropivacaine) or placebo blocks. Postoperative pain treatment consisted of oral acetaminophen 1000 mg × 4, oral ibuprofen 400 mg × 3, IV morphine (0-2 hours postoperatively), and oral ketobemidone (2-24 hours postoperatively). The primary outcome was postoperative pain scores while coughing calculated as area under the curve for the first 24 postoperative hours (AUC/24 h). Secondary outcomes were pain scores at rest (AUC/24 h), opioid consumption, and side effects. Patients were assessed 0, 2, 4, 6, 8, and 24 hours postoperatively. Group-wise comparisons of visual analog scale (VAS) pain (AUC/24 h) were performed with the 2-sample t test. Morphine and ketobemidone consumption were compared with the Mann-Whitney test for unpaired data. Categorical data were analyzed using the χ(2) test. RESULTS The primary outcome variable, VAS pain scores while coughing (AUC/24 h), was significantly reduced in the TAP versus the placebo group (P = 0.04); group TAP: 26 mm (SD 13) (weighted average level) versus group placebo: 34 (18) (95% confidence interval): 0.5-15 mm). VAS pain scores at rest (AUC/24 h) showed no significant difference between groups. Median morphine consumption (0-2 hours postoperatively) was 7.5 mg (interquartile range: 5-10 mg) in the placebo group compared with 5 mg (interquartile range: 0-5 mg) in the TAP group (P < 0.001). The odds ratio of a random patient in group TAP having less morphine consumption than a random patient in group placebo was P (group TAP < group placebo) = 0.26 (confidence interval: 0.15, 0.37) where 0.5 represents no difference between groups. There were no between-group differences in total ketobemidone consumption, levels of nausea and sedation, number of patients vomiting, or consumption of ondansetron. CONCLUSIONS TAP block after laparoscopic cholecystectomy may have some beneficial effect in reducing pain while coughing and on opioid requirements, but this effect is probably rather small.
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DOKSRØD S, SAGEN Ø, NØSTDAHL T, RAEDER J. Dexamethasone does not reduce pain or analgesic consumption after thyroid surgery; a prospective, randomized trial. Acta Anaesthesiol Scand 2012; 56:513-9. [PMID: 22924169 DOI: 10.1111/j.1399-6576.2012.02654.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Post-operative analgesic effect of a perioperative fixed dose glucocorticoid has been demonstrated in studies on different surgical procedures. The aim of this study was to look for analgesic and opioid sparing effect after thyroid surgery with a weight-adjusted medium dose of dexamethasone compared with placebo or a higher dose. Further, to register other effects and side effects of dexamethasone in the 0–30 days postoperative period. METHODS One hundred and twenty patients scheduled for thyroid surgery were randomly assigned to three groups receiving either dexamethasone 0.30 mg/kg, 0.15 mg/kg or placebo. Pain scores at rest and on coughing, post-operative nausea and vomiting (PONV), consumption of opioids and anti-emetics, appetite, sleep pattern, fatigue, mood, blood sugar, wound infection and dyspepsia were recorded. RESULTS There was no effect of either dexamethasone doses on post-operative pain or rescue opioid consumption. PONV was lower in the dexamethasone groups 2–4 h post-operatively (P < 0.01). Blood sugar increased moderately from baseline in all groups, but significantly more in the dexamethasone groups (P < 0.01 at 2 h and P < 0.001 at 4 h). Minor improvement in appetite was shown with dexamethasone, along with a tendency towards less sleep and more fatigue in the 3–30 days period for the higher dose. No effect was demonstrated on other parameters. CONCLUSION Dexamethasone had no analgesic or opioid sparing effect in our set-up after thyroid surgery. Dexamethasone reduced the incidence of PONV and led to a modest increase in blood sugar. A medium dose seems as effective as a higher dose.
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Affiliation(s)
- S. DOKSRØD
- Departement of Anaesthesiology; Telemark Hospital; Skien; Norway
| | - Ø. SAGEN
- Departement of Anaesthesiology; Telemark Hospital; Skien; Norway
| | - T. NØSTDAHL
- Departement of Anaesthesiology; Telemark Hospital; Skien; Norway
| | - J. RAEDER
- Departement of Anaesthesiology; Oslo University Hospital, Ullevaal - Oslo, Norway and Clinical Division, University of Oslo; Oslo; Norway
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White PF, White LM, Monk T, Jakobsson J, Raeder J, Mulroy MF, Bertini L, Torri G, Solca M, Pittoni G, Bettelli G. Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg 2012; 114:1190-215. [PMID: 22467899 DOI: 10.1213/ane.0b013e31824f19b8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As the number of ambulatory surgery procedures continues to grow in an aging global society, the implementation of evidence-based perioperative care programs for the elderly will assume increased importance. Given the recent advances in anesthesia, surgery, and monitoring technology, the ambulatory setting offers potential advantages for elderly patients undergoing elective surgery. In this review article we summarize the physiologic and pharmacologic effects of aging and their influence on anesthetic drugs, the important considerations in the preoperative evaluation of elderly outpatients with coexisting diseases, the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and offer recommendations regarding the management of common postoperative side effects (including delirium and cognitive dysfunction, fatigue, dizziness, pain, and gastrointestinal dysfunction) after ambulatory surgery. We conclude with a discussion of future challenges related to the growth of ambulatory surgery practice in this segment of our surgical population. When information specifically for the elderly population was not available in the peer-reviewed literature, we drew from relevant information in other ambulatory surgery populations.
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Affiliation(s)
- Paul F White
- Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy: a randomized controlled trial. Can J Anaesth 2012; 59:442-8. [PMID: 22383085 DOI: 10.1007/s12630-012-9684-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 02/15/2012] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Controversy surrounds the optimal technique to moderate pain after laparoscopic cholecystectomy (LC). Opioid analgesics, sympatholytic drugs, and adjuvants, such as ketamine, have all been used. We compared esmolol with a combination of remifentanil plus ketamine in patients undergoing LC to determine the impact of these drugs on morphine requirements and pain control. METHODS Sixty American Society of Anesthesiologists physical status I-II patients undergoing LC and anesthetized with sevoflurane were randomized to one of two groups. Group E patients received a bolus of esmolol 0.5 mg·kg(-1) iv at induction followed by an infusion of 5-15 μg·kg(-1)·min(-1), and Group R-K patients received a bolus of ketamine 0.5 mg·kg(-1) iv and remifentanil 0.5 μg·kg(-1) iv at induction followed by a remifentanil infusion titrated over a range of 0.1-0.5 μg·kg(-1)·min(-1). All patients received paracetamol, dexketoprofen, and levobupivacaine via infiltration of laparoscopic port sites. After surgery, a predetermined bolus of morphine was administered according to a verbal numerical rating scale (VNRS) for pain intensity. The primary outcome of interest was postoperative morphine requirement. RESULTS Median consumption of morphine was higher in Group R-K than in Group E (5 mg [4-6] vs 0 mg [0-2], respectively; P < 0.001). In the postanesthesia care unit, patients in Group R-K had higher pain scores than patients in Group E (difference in maximum VNRS, -11; 95% confidence interval (CI), -19 to -3). The concentration of sevoflurane to maintain a bispectral index~40 was higher in Group E than in Group R-K (between-group difference 0.3%; 95% CI, 0.15 to 0.40). The incidence of postoperative nausea and vomiting was similar between the two groups. CONCLUSION Intraoperative esmolol infusion reduces morphine requirements and provides more effective analgesia compared with a combination of remifentanil-ketamine given by infusion in patients undergoing LC.
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Experimental characterization of the effects of acute stresslike doses of hydrocortisone in human neurogenic hyperalgesia models. Pain 2012; 153:420-428. [DOI: 10.1016/j.pain.2011.10.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/31/2011] [Indexed: 11/24/2022]
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Asgari Z, Mozafar-Jalali S, Faridi-tazehkand N, Sabet S. Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2012; 6:59-64. [PMID: 25505513 PMCID: PMC4260641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 12/04/2011] [Indexed: 10/31/2022]
Abstract
BACKGROUND In this study, we tried to show the efficacy of Intraperitoneal dexamethasone on relieving shoulder pain after gynecologic laparoscopy. MATERIALS AND METHODS In this double-blind randomized clinical trial, 63 patients who were candidates for gynecologic laparoscopy were included. At the end of the procedure patients randomly received 16 mg dexamethasone (n=31) or placebo (n=32) intraperitoneally. Visual analogue scale (VAS) was used for clinical evaluation of pain severity during 24 hours after laparoscopy . A physician, who was not aware whether patients were treated with drug or placebo, evaluated the patients. RESULTS The severity of pain in the dexamethasone group within 0, 2, 4, 8, 12, 24 hours after procedure was significantly less than in the placebo group (p<0.001). The average consumption of opioids as analgesic/ sedative in the placebo group was more than the dexamethasone group (p=0.025). CONCLUSION Findings of this study show that the prescription of 16 mg of dexametha- sone (single dose) in the peritoneal cavity may significantly reduce the severity of pain after Laparoscopy in comparison with placebo and may decrease the need for narcotics as pain relief (Registration Number: IRCT201105306640N1).
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Affiliation(s)
- Zahra Asgari
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Mozafar-Jalali
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran,P.O.Box: 1653915981Department of Obstetrics and GynecologyArash HospitalTehranIran
| | - Nasrin Faridi-tazehkand
- Department of Anesthesiology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Sabet
- Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Combination of Dexamethasone and Tropisetron Before Thyroidectomy to Alleviate Postoperative Nausea, Vomiting, and Pain: Randomized Controlled Trial. World J Surg 2011; 36:1217-24. [DOI: 10.1007/s00268-011-1363-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Murphy GS, Sherwani SS, Szokol JW, Avram MJ, Greenberg SB, Patel KM, Wade LD, Vaughn J, Gray J. Small-Dose Dexamethasone Improves Quality of Recovery Scores After Elective Cardiac Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. J Cardiothorac Vasc Anesth 2011; 25:950-60. [DOI: 10.1053/j.jvca.2011.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Indexed: 11/11/2022]
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Lim SH, Jang EH, Kim MH, Cho K, Lee JH, Lee KM, Cheong SH, Kim YJ, Shin CM. Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia. Korean J Anesthesiol 2011; 61:315-9. [PMID: 22110885 PMCID: PMC3219778 DOI: 10.4097/kjae.2011.61.4.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 01/05/2011] [Accepted: 01/20/2011] [Indexed: 11/15/2022] Open
Abstract
Background Pain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia. Methods One hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder. Results VAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N. Conclusions A single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different.
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Affiliation(s)
- Se Hun Lim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Ahn Y, Woods J, Connor S. A systematic review of interventions to facilitate ambulatory laparoscopic cholecystectomy. HPB (Oxford) 2011; 13:677-86. [PMID: 21929667 PMCID: PMC3210968 DOI: 10.1111/j.1477-2574.2011.00371.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/09/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to perform a systematic review of the literature to identify interventions that may facilitate ambulatory laparoscopic cholecystectomy (LC). METHODS The PubMed and CENTRAL databases were interrogated for key MeSH headings. To be eligible for systematic review, trials were required to include outcome measures of postoperative pain, nausea or vomiting and time to discharge following LC. Interventions were subsequently assessed for the level of evidence and grade of recommendation given. RESULTS A total of 331 trials were identified, 68 of which met the predefined study inclusion criteria. Interventions which met Level I, Grade A recommendation included the administration of 8 mg i.v. dexamethasone, preoperative administration of analgesia including the use of non-steroidal anti-inflammatory or COX II inhibitors, intraoperative use of an anti-emetic, pre-incisional use of bupivacaine, administration of intraperitoneal bupivacaine on establishment of pneumoperitoneum, and avoidance of drains. CONCLUSIONS High-quality evidence describing interventions that minimize barriers to ambulatory LC exists. Further studies will be required to determine the optimal combination of these interventions.
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Affiliation(s)
- Yeri Ahn
- Department of Surgery, Christchurch HospitalChristchurch, New Zealand
| | - Jennifer Woods
- Department of Anaesthesia, Christchurch HospitalChristchurch, New Zealand
| | - Saxon Connor
- Department of Surgery, Christchurch HospitalChristchurch, New Zealand
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Jo YY, Yoo JH, Kim HJ, Kil HK. The effect of epidural administration of dexamethasone on postoperative pain: a randomized controlled study in radical subtotal gastrectomy. Korean J Anesthesiol 2011; 61:233-7. [PMID: 22025946 PMCID: PMC3198185 DOI: 10.4097/kjae.2011.61.3.233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 02/23/2011] [Accepted: 03/03/2011] [Indexed: 12/03/2022] Open
Abstract
Background Epidurally administered dexamethasone may reduce the incidence and severity of postoperative pain. We investigated whether postoperative pain could be alleviated by preoperative or postoperative epidural dexamethasone administration in patients undergoing major abdominal surgery. Methods Ninety patients (age 30-77 with American Society of Anesthesiologists physical status I and II) undergoing radical subtotal gastrectomy were randomly allocated to three groups using computer generated randomization. In all groups, 10 ml of 0.25% ropivacaine was injected epidurally before the start and at the end of the operation. In Group I, a bolus ropivacaine epidural without dexamethasone was administered. In Group II, dexamethasone (5 mg) was added to the ropivacaine bolus epidural before the start of operation. In Group III, the same amount of dexamethasone was given with the ropivacaine epidural at the end of operation. Effort and resting VAS, the use of rescue analgesics and any complications noted during the procedure were evaluated. Results VAS and requirements of rescue analgesics were significantly lower in Groups II and III when compared to Group I. There were no difference in the incidence of nausea and vomiting between groups, but an itching sensation was frequent in Group III. Conclusions The administration of 5 mg of dexamethasone epidurallly, before or after operation, could reduce the pain and analgesic requirement after radical subtotal gastrectomy.
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Affiliation(s)
- Youn Yi Jo
- Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center, Incheon, Korea
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Lee Y, Tzeng JI. Dexamethasone: not only an effective antiemetic. ACTA ANAESTHESIOLOGICA TAIWANICA : OFFICIAL JOURNAL OF THE TAIWAN SOCIETY OF ANESTHESIOLOGISTS 2011; 49:81-82. [PMID: 21982166 DOI: 10.1016/j.aat.2011.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Cummings K, Napierkowski D, Parra-Sanchez I, Kurz A, Dalton J, Brems J, Sessler D. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth 2011; 107:446-53. [DOI: 10.1093/bja/aer159] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Validation of the DeLiT Trial intravenous insulin infusion algorithm for intraoperative glucose control in noncardiac surgery: a randomized controlled trial. Can J Anaesth 2011; 58:606-616. [DOI: 10.1007/s12630-011-9509-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/08/2011] [Indexed: 11/29/2022] Open
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Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: A randomized clinical controlled trial. Head Neck 2011; 33:840-846. [DOI: 10.1002/hed.21543] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy? Surg Laparosc Endosc Percutan Tech 2011; 19:506-10. [PMID: 20027097 DOI: 10.1097/sle.0b013e3181bd9149] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stress response after laparoscopic cholecystectomy (LC) is less compared with open cholecystectomy, but is still responsible for significant postoperative morbidity. Though preoperative glucocorticoids were found to be effective in reducing the response in open surgical procedures, their role in minimal access surgery is not clear. AIMS AND OBJECTIVES To evaluate the efficacy of single-dose preoperative dexamethasone in reducing the stress response and postoperative morbidity after LC. MATERIALS AND METHODS In a prospective randomized, double-blind, placebo-controlled trial, 70 patients undergoing elective LC were randomized to receive either dexamethasone (8 mg intravenously), or placebo. The change in C-reactive protein levels after LC, pain scores at rest, and on exertion and narcotic requirements, the incidence and severity of postoperative nausea and vomiting (PONV), anti-emetic requirement, peak expiratory flow rate in both groups were compared. RESULTS Dexamethasone was more effective in controlling late PONV (P=0.05). The antiemetic requirement was significantly less in the dexamethasone group (0.56 mg vs. 2.24 mg; P=0.02). Median pain scores were significantly less in the dexamethasone group at 24 hours at rest (P=0.002) and on exertion at 24 and 48 hours (P=0.03 and 0.001). Analgesic requirement was less in the test group (22.9 mg vs. 29.9 mg; P=0.054). The peak expiratory flow rate at 48 hours was higher in the dexamethasone group (315.28 vs. 285.8 l/min; P=0.04). The dexamethasone group showed significantly less elevation of C-reactive protein levels at 24 hours (7.17 microg/mL vs. 17.53 microg/mL; P=0.003) and 48 hours (10.65 microg/mL vs. 23.18 microg/mL; P=0.02) postoperatively. CONCLUSIONS Preoperative single-dose dexamethasone significantly reduces the pain scores, PONV, and antiemetic requirements while improving the respiratory function in the postoperative period after LC.
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Abstract
Corticosteroids are widely used as treatment for excessive scarring by intralesional injection with variable success rates. It is conceivable that systemically administered corticosteroids affect a wider range of inflammatory processes that influence wound healing and may be more successful in preventing hypertrophic scar formation. To study this presumption, we have used a standardized model of presternal scars caused by cardiothoracic surgery through a median sternotomy incision. During cardiac surgery with cardiopulmonary bypass, 1 mg/kg dexamethasone was administered preoperatively, and 0.5 mg/kg 8 hours postoperatively. The presternal scars were evaluated prospectively 2, 4, 6, 12, and 52 weeks postoperatively at standardized measuring points. The height and width of the scars were measured 12 and 52 weeks postoperatively using both a slide caliper and a 7.5-MHz ultrasound probe. Cardiopulmonary bypass was used in 31 of the 43 participants. Eleven patients (35%) in the dexamethasone group developed clinical hypertrophic scars compared with 4 patients (33%) in the control group. These differences were not statistically significant. However, cranial scars became significantly wider in the dexamethasone group compared with the control group (P = 0.04). Twelve weeks postoperatively scars were significantly higher in the dexamethasone group, both cranial (P = 0.05) and caudal (P = 0.03). The differences in scar width and height were mainly present in patients that developed hypertrophic scars. The present results suggest that administration of high-dose perioperative dexamethasone does not prevent hypertrophic scar formation. Its use together with the cardiopulmonary bypass, however, did affect scar dimensions negatively up to 52 weeks after surgery. These findings contribute to the concept of the involvement of perioperative immunologic responses in the etiology of hypertrophic scar formation.
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Preoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk. Curr Opin Anaesthesiol 2010; 23:682-6. [DOI: 10.1097/aco.0b013e32833ff302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Surgery is undergoing revolutionary change as a result of newer approaches to pain control, the introduction of techniques that reduce the post-operative stress response, and the use of minimally invasive operations, such as laparoscopic surgery. As demand for hospital beds continues to escalate, it is paramount that patients recover from surgery quickly and safely; the use of evidence-based interventions to hasten recovery within an enhanced recovery programme (ERP) can play a vital role in achieving this, as well as reducing costs by shortening hospital stay. This article outlines the principles and key elements of an ERP, and discusses how it can help to achieve an improved and safe recovery and shorter hospital stay for patients, thereby reducing the cost to the NHS of inpatient treatment and recovery. The literature surrounding the development of 'enhanced recovery' (also called 'fast-track') surgery is reviewed to determine whether it is appropriate for patients undergoing elective colorectal surgery.
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Affiliation(s)
- Rebecca Slater
- Department of Stoma Care, St Marks Hospital, Harrow, Middlesex
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