High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial

• Published in: European journal of cardio-thoracic surgery Vol. 53; no. 1; pp. 209 - 215
• Main Authors: Bjerregaard, Lars S, Jensen, Per F, Bigler, Dennis R, Petersen, René Horsleben, Møller-Sørensen, Hasse, Gefke, Kaj, Hansen, Henrik J, Kehlet, Henrik
• Format: Journal Article
• Language: English
• Published: Germany 01.01.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Double-Blind Method; Drug Administration Schedule; Elective Surgical Procedures; Female; Follow-Up Studies; Humans; Male; Methylprednisolone - administration & dosage; Methylprednisolone - therapeutic use; Middle Aged; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - prevention & control; Pneumonectomy - methods; Preoperative Care; Thoracic Surgery, Video-Assisted; Treatment Outcome; Young Adult; Postoperative; Pain; Methylprednisolone; Video assisted thaoracic surgery; Steroids
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezx248

The optimal postoperative analgesic strategy after video-assisted thoracoscopic surgery lobectomy remains undetermined. We hypothesized that high-dose preoperative methylprednisolone (MP) would improve analgesia compared to placebo. A total of 120 adult patients were randomized equally to 125 mg MP or placebo before the start of their elective video-assisted thoracoscopic surgery lobectomy. Group allocation was blinded to patients, investigators and caregivers, and all patients received standardized multimodal, opioid-sparing analgesia. Our primary outcome was area under the curve on a numeric rating scale from 0 to 10, for pain scores on the day of surgery and on postoperative days 1 and 2. Clinical follow-up was 2-3 weeks, and telephone follow-up was 12 weeks after surgery. Ninety-six patients were included in the primary analysis. Methylprednisolone significantly decreased median pain scores on the day of surgery: at rest (numeric rating scale 1.6 vs 2.0, P = 0.019) and after mobilization to a sitting position (numeric rating scale 1.7 vs 2.5, P = 0.004) but not during arm abduction and coughing (P = 0.052 and P = 0.083, respectively). Nausea and fatigue were reduced on the day of surgery (P = 0.04 and 0.03), whereas no outcome was improved on postoperative Days 1 and 2. Methylprednisolone did not increase the risk of complications but increased blood glucose levels on the day of surgery (P < 0.0001). High-dose preoperative MP significantly reduced pain at rest and after mobilization to a sitting position on the day of surgery, without later analgesic effects. Nausea and fatigue were improved without side effects, except transient higher postoperative blood glucose levels. Registered at clinicaltrialsregister.eu [7 November 2012, EudraCT 2012-004451-37; https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-004451-37/DK].