Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Effect of Perioperative Systemic Dexamethasone on Pain, Edema, and Trismus in Mandibular Fracture Surgery: A Randomized Trial

ABSTRACT

The authors' aim was to evaluate the effect of perioperative systemic dexamethasone (DXM) administration on postoperative pain, edema, and trismus in mandibular fracture patients. The authors conducted a prospective randomized study of 45 patients with one or 2 noncomminuted fractures of the dentate part of the mandible. All patients underwent surgery for intraoral miniplate fixation. Patients in the study group were given a total of 30 mg DXM, while patients in the control group received neither DXM nor placebo. Only paracetamol and opioids were served as analgesics. Pain severity was assessed using the visual analog scale. The effect in facial swelling was measured in centimeters and analyzed as percentage change. Trismus was evaluated as the difference in maximal mouth opening by measuring interincisal distance in millimeters. The Mann-Whitney U test was applied to determine the statistical significance of differences between the groups. Thirty-four patients were included in the statistical analysis. The visual analog scale score was significantly lower in the study group than in the control group at 18 hours postoperatively (P = 0.033). Significant differences in edema or trismus were not found postoperatively between the DXM and control groups. In conclusion, perioperative DXM decreases postoperative pain in mandibular fracture patients when nonsteroidal anti-inflammatory drugs are not used, but it does not seem to be effective in reducing edema or trismus.

Do the Benefits of Systemic Corticosteroids Outweigh Adverse Effects During Maxillofacial Trauma Surgery? A Systematic Review and Meta-Analysis

PURPOSE

Perioperative systemic corticosteroids are widely used in maxillofacial trauma surgery to prevent postoperative complications, but potentially perceived benefits are speculative rather than evidence-based. The purpose of our systematic review and meta-analysis was to assess the effects of perioperative systemic corticosteroids on clinically significant outcomes in patients undergoing maxillofacial trauma surgery.

METHODS

We searched Medline, Embase, CENTRAL, Clinical trial registry, and grey literature as well as references of included trials. Our primary outcomes were facial edema and pain after the surgery. Our secondary outcomes were postoperative nausea and vomiting, neurosensory disturbance, functional recovery, wound infections, and other adverse events.

RESULTS

Of the 94 trials retrieved, 13 were included (n = 652). Perioperative steroid use was associated with reduced pain and facial edema. We observed a decrease in postoperative nausea and vomiting with the use of systemic corticosteroids (n = 184, OR = 0.53, [0.28, 1.02], I² = 0%). Four trials reported infections and impaired wound healing associated with steroids (n = 160. OR = 3.37, [1.43. 7.94], I² = 2%). The 13 trials had an unclear risk of bias.

CONCLUSIONS

Systemic corticosteroids reduced facial edema and postoperative pain, but impaired wound healing was also reported. The use of systemic steroids in maxillofacial trauma surgery is thus supported only by weak evidence and further research is advocated.

Attitudes towards the use of perioperative steroids in resectional colorectal cancer surgery in the UK: A qualitative study

Introduction

Resectional surgery remains the mainstay of treatment for colorectal cancer. A heightened postoperative systemic inflammatory response has been shown to correlate negatively with short/long-term outcomes. Perioperative steroid administration may help to alleviate this systemic inflammatory response. This survey has been carried out to assess current attitudes towards perioperative steroid use and to gauge interest in a randomised control trial in this area.

Method

An internet-based survey consisting of 9 questions was circulated via email. Those responses from outside the United Kingdom were excluded.

Result

74 doctors from the United Kingdom, predominantly Consultant Anaesthetists (54%) responded to this survey. 77% gave some or all of their patients steroids, in 75% of cases at the discretion of the anaesthetist. The main perceived benefit was to reduce postoperative nausea and vomiting. Diabetics and those deemed at high risk of wound infection were the group in whom most respondents would be reluctant to give steroids. 32% of respondents had no concerns. 87% of respondents felt that a randomised trial in this field would be of clinical interest with most respondents (58%) preferring a three-armed trial – no steroids vs low dose steroids vs high dose steroids.

Conclusion

This survey indicated that perioperative steroid use is currently widespread. Sufficient equipoise exists for a trial in this area with regard to examining the impact of dexamethasone on postoperative complications and the postoperative systemic inflammatory response. Respondents favoured a 3-armed trial – no steroids vs low-dose steroids vs high-dose steroids.

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Currently, the use of perioperative steroids is common, although not routine in resectional colorectal surgery.

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Perioperative steroids are currently administered with the aim of reducing postoperative nausea and vomiting.

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There is sufficient equipoise to carry out an RCT studying perioperative dexamethasone and outcomes in colorectal resection.