Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery

• Published in: British journal of anaesthesia : BJA Vol. 107; no. 3; pp. 362 - 371
• Main Authors: De Oliveira, G.S., Ahmad, S., Fitzgerald, P.C., Marcus, R.J., Altman, C.S., Panjwani, A.S., McCarthy, R.J.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.09.2011; Oxford University Press
• Subjects: Adult; Ambulatory Surgical Procedures; anaesthesia; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia Recovery Period; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Dexamethasone - administration & dosage; Dose-Response Relationship, Drug; Double-Blind Method; Female; general, gynaecological, recovery; Gynecologic Surgical Procedures; Humans; Laparoscopy; Medical sciences; Middle Aged; Pain, Postoperative - drug therapy; Patient Discharge; Prospective Studies; recovery, postoperative, pain, postoperative, dexamethasone, postoperative nausea and vomiting; Surveys and Questionnaires; general, gynaecological, recovery; anaesthesia; recovery, postoperative, pain, postoperative, dexamethasone, postoperative nausea and vomiting; Postoperative; Corticosteroid; Dexamethasone; Steroid hormone; Antiinflammatory agent; Nausea; recovery; postoperative nausea and vomiting; general; Pain; Vomiting; Surgery; Digestive diseases; Anesthesia; Ambulatory; Preoperative; gynaecological
• ISSN: 0007-0912; 1471-6771; 1471-6771
• DOI: 10.1093/bja/aer156

Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery. This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg−1 or dexamethasone 0.1 mg kg−1 before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated. Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg−1 193 (192–195) was greater than dexamethasone 0.05 mg kg−1 179 (175–185) (P=0.004) or saline, 171 (160–182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (0–6.3) mg after dexamethasone 0.1 mg kg−1 compared with 5.3 (2.4–8.8) mg and 5.3 (2.7–7.8) mg after dexamethasone 0.05 mg kg−1 and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg−1 compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg−1 had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg−1 and saline. Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg−1 reduced opioid consumption compared with dexamethasone 0.05 mg kg−1, which may be beneficial for improving recovery after ambulatory gynaecological surgery.