Benefits versus harm of intraoperative glucocorticoid for postoperative nausea and vomiting prophylaxis.
(2023) British Journal of Anaesthesia — Vol. 131, n° 1, p. 8-10 (2023)
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- Abstract
- 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.
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Citations
Lavand’homme, P., & Kehlet, H. (2023). Benefits versus harm of intraoperative glucocorticoid for postoperative nausea and vomiting prophylaxis. British Journal of Anaesthesia, 131(1), 8-10. https://doi.org/10.1016/j.bja.2023.04.013 (Original work published 2023)