Benefits versus harm of intraoperative glucocorticoid for postoperative nausea and vomiting prophylaxis

• Published in: British journal of anaesthesia : BJA Vol. 131; no. 1; pp. 8 - 10
• Main Authors: Lavand'homme, Patricia, Kehlet, Henrik
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2023
• Subjects: Antiemetics - therapeutic use; chronic post-surgical pain; dexamethasone; Dexamethasone - therapeutic use; glucocorticoids; Glucocorticoids - therapeutic use; Humans; PADDI trial; Pain, Postoperative - drug therapy; Pain, Postoperative - prevention & control; Postoperative Nausea and Vomiting - complications; postoperative pain; postoperative recovery; Surgical Wound Infection - drug therapy; wound pain; dexamethasone; wound pain; chronic post-surgical pain; postoperative pain; glucocorticoids; PADDI trial; postoperative recovery
• DOI: 10.1016/j.bja.2023.04.013
• ISSN: 0007-0912; 1471-6771

Intraoperative use of glucocorticoids is effective for postoperative nausea and vomiting prophylaxis and can also provide early postoperative analgesic effects, but the consequences for chronic post-surgical pain are debatable. In a secondary analysis of the large pragmatic Perioperative Administration of Dexamethasone and Infection trial (n=8478), the primary outcome of pain at the surgical wound at 6 months after surgery was increased in subjects receiving dexamethasone 8 mg i.v. for postoperative nausea and vomiting prophylaxis, a dose not associated with the detrimental effect of surgical site infection in the original study. In contrast, a more detailed assessment of chronic post-surgical pain after exclusion of patients with preoperative pain at the surgical site showed no differences with or without intraoperative dexamethasone regarding chronic post-surgical pain characteristics (intensity and neuropathic features). Because of several confounding factors especially regarding surgical details, these unexpected findings call for more well-designed studies about the potential risk of intraoperative treatments, such as glucocorticoids, on late post-surgical pain.