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Randomized Controlled Trial
. 2023 Aug;34(8):1781-1788.
doi: 10.1007/s00192-023-05461-0. Epub 2023 Feb 2.

Dexamethasone administration to improve patient recovery in ambulatory vaginal reconstructive surgery: a randomized prospective trial

Hemikaa Devakumar  1   2 , David Ossin  3 , Laura Martin  3 , Lawrence Frank  4 , Eric Hurtado  3 , G Willy Davila  5
Affiliations
Randomized Controlled Trial

Dexamethasone administration to improve patient recovery in ambulatory vaginal reconstructive surgery: a randomized prospective trial

Hemikaa Devakumar et al. Int Urogynecol J. 2023 Aug.

Abstract

Introduction and hypothesis: Dexamethasone is a potent glucocorticoid that may improve quality of recovery (QoR). We hypothesized that standard administration of dexamethasone at induction may improve QoR compared to placebo in subjects undergoing ambulatory vaginal reconstructive surgeries.

Methods: This was a randomized prospective clinical trial on subjects scheduled for ambulatory vaginal reconstructive surgery for prolapse and/or urinary incontinence. Intervention arm subjects were administered dexamethasone and the control group, a placebo (normal saline). Timing of administration, anesthesia medications, postoperative pain medications, and antiemetics were standardized. Primary outcome was difference in QoR (QoR-40) scores 24-48 h after surgery. Power analysis estimated that 27 subjects were required in each group to detect a difference in QoR-40 scores with 80% power and an alpha of 0.05.

Results: Fifty-one subjects were enrolled and randomized. 4 withdrew, 1 was excluded, and 46 were analyzed. For the primary outcome, there was no difference in the QoR-40 between the dexamethasone and placebo group (--13.5 vs -19.6, p=0.24). Postoperative nausea vomiting intensity scores were not different (8.33 vs 9.09, p=1). Pain scores were similar in the two groups (6.0 vs 4.7, p=0.12). Although not statistically significant, surgical satisfaction at 6 weeks was better with dexamethasone (23.5 vs 26.9, p=0.09).

Conclusion: Based on this study, a single dose of dexamethasone at the time of induction prior to ambulatory vaginal reconstructive surgery was not associated with improved QoR. Standardized anesthesia protocols may play a role in postoperative nausea, pain control, and thereby QoR in patients undergoing ambulatory vaginal reconstructive surgeries.

Keywords: Dexamethasone; Postoperative nausea and vomiting; Quality of recovery.

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References

    1. Leader S, Moon M. Medicare trends in ambulatory surgery. Health Aff (Millwood). 1989;8(1):158–70. - DOI - PubMed
    1. Alas AN, Espaillat L, Plowright L, Aguilar V, Davila GW. Same-day surgery for pelvic organ prolapse and urinary incontinence: assessing satisfaction and morbidity. Perioper Care Oper. 2016;5:20–6. https://doi.org/10.1016/j.pcorm.2016.12.003 . - DOI
    1. Myles PS, Reeves MD, Anderson H, Weeks AM. Measurement of quality of recovery in 5672 patients after anaesthesia and surgery. Anaesth Intensive Care. 2000;28(3):276–80. - DOI - PubMed
    1. Blitz JD, Haile M, Kline R, et al. A randomized double blind study to evaluate efficacy of palonosetron with dexamethasone versus palonosetron alone for prevention of postoperative and postdischarge nausea and vomiting in subjects undergoing laparoscopic surgeries with high emetogenic risk. Am J Ther. 2012;19(5):324–9. https://doi.org/10.1097/MJT.0b013e318209dff1 . - DOI - PubMed
    1. D'souza N, Swami M, Bhagwat S. Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery. Int J Gynaecol Obstet. 2011;113(2):124–7. https://doi.org/10.1016/j.ijgo.2010.11.022 . - DOI - PubMed

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