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Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

Preoperative dexamethasone for acute post-thoracotomy analgesia: a randomized, double-blind, placebo-controlled study

Authors: Kyoung-Woon Joung, Hyeong Ryul Kim, Wook-Jong Kim, Ye Ji Lim, Jae Won Kim, Eun-Ho Lee, In-Cheol Choi

Published in: BMC Anesthesiology | Issue 1/2018

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Abstract

Background

The analgesic effects of dexamethasone have been reported previously, and the present study determined the effects of preoperative dexamethasone on postoperative pain in patients who received thoracotomy.

Methods

Forty patients participated in this randomized, double-blind study. All patients received either dexamethasone via a 0.1 mg/kg intravenous bolus before anesthetic induction or an equal volume of saline. Postoperative analgesia was provided to both groups via epidural patient-controlled analgesia (PCA), which consisted of 250 μg of sufentanil in 250 mL of ropivacaine (0.18%) for 72 h. The primary outcome was the cumulative consumption of epidural PCA at postoperative 24 and 72 h. The secondary outcomes were the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay.

Results

No significant differences was observed in the consumption of epidural PCA between the control and dexamethasone infusion groups at 24 h (63.6 [55.9–72.7] vs. 68.5 [60.2–89.0] ml, P = 0.281) and 72 h (199.4 [172.4–225.1] vs. 194.7 [169.1–252.2] ml, P = 0.890). Moreover, there was no significant difference in the pain intensity scores during resting and coughing at postoperative 24 and 72 h, quality of recovery, total amount of rescue analgesics required, and length of hospital stay.

Conclusion

A single intravenous administration of dexamethasone during the preoperative period does not reduce opioid consumption and post-thoracotomy pain.

Trial registration

The study was registered at http://cris.nih.go.kr (KCT0000359) and was conducted from December 2011 to October 2012.
Literature
1.
go back to reference Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth. 2010;104:292–7.CrossRef Ali M, Winter DC, Hanly AM, O'Hagan C, Keaveny J, Broe P. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life. Br J Anaesth. 2010;104:292–7.CrossRef
2.
go back to reference Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961–4.CrossRef Baxendale BR, Vater M, Lavery KM. Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anaesthesia. 1993;48:961–4.CrossRef
3.
go back to reference Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars. Oral Surg Oral Med Oral Pathol. 1986;61:134–8.CrossRef Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars. Oral Surg Oral Med Oral Pathol. 1986;61:134–8.CrossRef
4.
go back to reference 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;33:840–6.CrossRef 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;33:840–6.CrossRef
5.
go back to reference Fukami Y, Terasaki M, Okamoto Y, Sakaguchi K, Murata T, Ohkubo M, et al. Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study. J Hepato-Biliary-Pancreat Surg. 2009;16:367–71.CrossRef Fukami Y, Terasaki M, Okamoto Y, Sakaguchi K, Murata T, Ohkubo M, et al. Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study. J Hepato-Biliary-Pancreat Surg. 2009;16:367–71.CrossRef
6.
go back to reference Thangaswamy CR, Rewari V, Trikha A, Dehran M, Chandralekha. Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose-response study. Journal of Anesthesia. 2010;24:24–30.CrossRef Thangaswamy CR, Rewari V, Trikha A, Dehran M, Chandralekha. Dexamethasone before total laparoscopic hysterectomy: a randomized controlled dose-response study. Journal of Anesthesia. 2010;24:24–30.CrossRef
7.
go back to reference 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. 2013;110:191–200.CrossRef 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. 2013;110:191–200.CrossRef
8.
go back to reference Scott M, Fishman JCB, James P. Rathmell: Bonica's management of pain. 4th ed. Lippincott: Willams & Wilkins; 2010. Scott M, Fishman JCB, James P. Rathmell: Bonica's management of pain. 4th ed. Lippincott: Willams & Wilkins; 2010.
9.
go back to reference Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9:105–21.CrossRef Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9:105–21.CrossRef
10.
go back to reference Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB. What decline in pain intensity is meaningful to patients with acute pain? Pain. 2003;105:151–7.CrossRef Cepeda MS, Africano JM, Polo R, Alcala R, Carr DB. What decline in pain intensity is meaningful to patients with acute pain? Pain. 2003;105:151–7.CrossRef
11.
go back to reference Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–14.CrossRef Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4:407–14.CrossRef
12.
13.
go back to reference Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2014;28:1048–56.CrossRef Doan LV, Augustus J, Androphy R, Schechter D, Gharibo C. Mitigating the impact of acute and chronic post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2014;28:1048–56.CrossRef
14.
go back to reference Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26:355–67 vii.CrossRef Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26:355–67 vii.CrossRef
15.
go back to reference Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104:594–600.CrossRef Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104:594–600.CrossRef
16.
go back to reference Mensah-Nyagan AG, Meyer L, Schaeffer V, Kibaly C, Patte-Mensah C. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology. 2009;34(Suppl 1):S169–77.CrossRef Mensah-Nyagan AG, Meyer L, Schaeffer V, Kibaly C, Patte-Mensah C. Evidence for a key role of steroids in the modulation of pain. Psychoneuroendocrinology. 2009;34(Suppl 1):S169–77.CrossRef
17.
go back to reference Watanabe S, Bruera E. Corticosteroids as adjuvant analgesics. J Pain Symptom Manag. 1994;9:442–5.CrossRef Watanabe S, Bruera E. Corticosteroids as adjuvant analgesics. J Pain Symptom Manag. 1994;9:442–5.CrossRef
19.
go back to reference Asad MV, Khan FA. Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery. J Anaesthesiol Clin Pharmacol. 2015;31:339–43.CrossRef Asad MV, Khan FA. Effect of a single bolus of dexamethasone on intraoperative and postoperative pain in unilateral inguinal hernia surgery. J Anaesthesiol Clin Pharmacol. 2015;31:339–43.CrossRef
20.
go back to reference Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study. Anesth Analg. 2006;102:605–9.CrossRef Bigat Z, Boztug N, Hadimioglu N, Cete N, Coskunfirat N, Ertok E. Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia? A randomized, controlled clinical study. Anesth Analg. 2006;102:605–9.CrossRef
21.
go back to reference Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth. 2013;111:445–52.CrossRef Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, et al. I.V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single-shot interscalene block with ropivacaine for shoulder surgery: a prospective, randomized, placebo-controlled study. Br J Anaesth. 2013;111:445–52.CrossRef
22.
go back to reference Lee C, Kim TY. The effect of preoperative dexamethasone administration, according to age and gender on postoperative pain in patients who undergo laparoscopic Choelecystectomy. Korean J Pain. 2008;21:51–6.CrossRef Lee C, Kim TY. The effect of preoperative dexamethasone administration, according to age and gender on postoperative pain in patients who undergo laparoscopic Choelecystectomy. Korean J Pain. 2008;21:51–6.CrossRef
23.
go back to reference De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115:575–88.CrossRef De Oliveira GS Jr, Almeida MD, Benzon HT, McCarthy RJ. Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2011;115:575–88.CrossRef
24.
go back to reference Senard M, Deflandre EP, Ledoux D, Roediger L, Hubert BM, Radermecker M, et al. Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy. Br J Anaesth. 2010;105:196–200.CrossRef Senard M, Deflandre EP, Ledoux D, Roediger L, Hubert BM, Radermecker M, et al. Effect of celecoxib combined with thoracic epidural analgesia on pain after thoracotomy. Br J Anaesth. 2010;105:196–200.CrossRef
25.
go back to reference Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63.CrossRef Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;20:455–63.CrossRef
Metadata
Title
Preoperative dexamethasone for acute post-thoracotomy analgesia: a randomized, double-blind, placebo-controlled study
Authors
Kyoung-Woon Joung
Hyeong Ryul Kim
Wook-Jong Kim
Ye Ji Lim
Jae Won Kim
Eun-Ho Lee
In-Cheol Choi
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0599-0

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