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Chen W, Li G, Jiang K, Song J, Du R, Yang H, Gou J, Li Z, Zhu J, Lei J. Dexamethasone for Postoperative Nausea and Vomiting in Papillary Thyroid Carcinoma Patients: A Randomized Clinical Trial. J Am Coll Surg 2022; 235:454-467. [PMID: 35972165 DOI: 10.1097/xcs.0000000000000309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) frequently occur after thyroidectomy. Previous studies have investigated the effects of preoperative dexamethasone for alleviating PONV in various cancers, but studies focused on papillary thyroid carcinoma (PTC) were limited. This study aimed to determine the efficacy of a single preoperative dose of dexamethasone to prevent PONV in patients with PTC. METHODS This single-center, parallel-group, double-blind, placebo-controlled clinical trial was conducted on patients with PTC in West China Hospital. Patients were randomized 1:1 into Group Dex (preoperative 8-mg dexamethasone) or Group Control (0.9% NaCl as control). The primary outcome was the incidence and severity of PONV. The secondary outcomes included postoperative pain, vocal dysfunction, and adverse events. RESULTS Six hundred participants were recruited and randomized. The total incidence of PONV was 33.3% (200 of 600 patients; 95% CI, 29.6-37.1). In the intention-to-treat analysis, PONV occurred in 81 of 300 patients (27.0%; 95% CI, 21.9-32.1) in Group Dex and in 119 of 300 patients (39.7%; 95% CI, 34.1-45.2) in Group Control (p = 0.001), and the absolute risk reduction was 12.7% (95% CI, 5.1-20.0). Patients in Group Dex reported fewer antiemetic requirements than those in Group Control (p = 0.004). Multivariate analysis indicated that dexamethasone administration (OR = 0.546; 95% CI, 0.383-0.777; p = 0.001) was associated with a reduced rate of PONV. Dexamethasone treatment also contributed to alleviating postoperative pain and improving subjective vocal dysfunction, with no increase in adverse events. CONCLUSIONS A single dose of dexamethasone is effective and safe for preventing PONV in PTC patients.
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Affiliation(s)
- Wenjie Chen
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Chen)
| | - Genpeng Li
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
| | - Ke Jiang
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
- Department of Head and Neck Surgery, Sun Yat Sen University Cancer Center, Guangzhou, China (Jiang)
| | - Jinen Song
- State Key Laboratory of Biotherapy, Center for Statistical Science, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China (Song)
| | - Runzi Du
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China (Du)
| | - Hui Yang
- Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China (Yang)
| | - Juxiang Gou
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
| | - Zhihui Li
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
| | - Jingqiang Zhu
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
| | - Jianyong Lei
- From the Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China (Chen, Li, Jiang, Gou, Li, Zhu, Lei)
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Liao J, Li M, Gan J, Xiao J, Xiang G, Ding X, Jiang R, Li P. Systematic review and meta-analysis of the efficacy of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery. Gland Surg 2021; 10:3106-3115. [PMID: 34926226 PMCID: PMC8637070 DOI: 10.21037/gs-21-719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Breast cancer is a malignant tumor disease that poses a significant threat to women's health. In recent years, the incidence of breast cancer in China has been increasing. This report aims to explore the effects of general anesthesia combined with a thoracic nerve block in modified breast cancer surgery. METHODS A computer-based search of PubMed, Web of Science, Embase, and the Cochrane Library was performed to identify randomized controlled studies on breast cancer, general anesthesia combined with a thoracic nerve block, modified breast cancer surgery, and other breast cancer treatments. Further search criteria included postoperative pain score, postoperative morphine equivalents given 24 hours after surgery, and operation duration. After an initial selection process, the studies were evaluated using the Jadad scale and the Cochrane Handbook for Systematic Reviews of Interventions to assess their suitability for inclusion in the subsequent meta-analysis of the experimental data, which was carried out using RevMan 5.3. RESULTS A total of 8 studies comprising a total of 624 patients were selected for inclusion in this report. According to the meta-analysis, the analytical structure of the thoracic nerve group and the control group had a mean difference (MD) of -1.27 [95% confidence interval (CI): -1.68 to -0.86], the structure of the statistical test was Z=6.08 (P<0.00001), the MD of the total analysis structure of morphine equivalents was -2.71 (95% CI: -4.98 to -0.44), and the statistical test structure was Z=2.34 (P=0.02). DISCUSSION General anesthesia combined with a thoracic nerve block in breast cancer surgery may effectively improve postoperative pain in patients and reduce the need for analgesic drugs. However, the outcome indicators included in this study are not sufficient. It is necessary to increase both the sample size and the number of outcome indicators to provide further theoretical evidence for the subsequent application of thoracic nerve block in modified breast cancer surgery.
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Affiliation(s)
- Juan Liao
- Department of Stomatology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Meiting Li
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiaqi Gan
- Department of Anesthesiology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
- Chengdu Medical College, Chengdu, China
| | - Jie Xiao
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chengdu Medical College, Chengdu, China
| | - Guilin Xiang
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chengdu Medical College, Chengdu, China
| | - Xizhi Ding
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Jiang
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Li
- Department of Anesthesiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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