Effects of prophylactic dexamethasone on postoperative nausea and vomiting in scoliosis correction surgery: a double-blind, randomized, placebo-controlled clinical trial

Rie Wakamiya, Hiroyuki Seki, Satoshi Ideno, Naho Ihara, Rie Minoshima, Kota Watanabe, Yasunori Sato, Hiroshi Morisaki, Rie Wakamiya, Hiroyuki Seki, Satoshi Ideno, Naho Ihara, Rie Minoshima, Kota Watanabe, Yasunori Sato, Hiroshi Morisaki

Abstract

Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58-0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of the study patients.

References

    1. Rullander, A. C., Jonsson, H., Lundstrom, M. & Lindh, V. Young people’s experiences with scoliosis surgery: a survey of pain, nausea, and global satisfaction. Orthop Nurs32, 327–333; quiz 334–325 (2013).
    1. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652–658.
    1. Parra-Sanchez I, et al. A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery. Can J Anaesth. 2012;59:366–375. doi: 10.1007/s12630-011-9660-x.
    1. Gan TJ. Postoperative nausea and vomiting–can it be eliminated? JAMA. 2002;287:1233–1236. doi: 10.1001/jama.287.10.1233.
    1. Gan TJ, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118:85–113. doi: 10.1213/ANE.0000000000000002.
    1. Steward, D. L., Grisel, J. & Meinzen-Derr, J. Steroids for improving recovery following tonsillectomy in children. Cochrane Database Syst Rev, CD003997 (2011).
    1. Madan R, et al. Prophylactic dexamethasone for postoperative nausea and vomiting in pediatric strabismus surgery: a dose ranging and safety evaluation study. Anesth Analg. 2005;100:1622–1626. doi: 10.1213/01.ANE.0000150977.14607.E1.
    1. Palmer GM, Pirakalathanan P, Skinner AV. A multi-centre multi-national survey of anaesthetists regarding the range of anaesthetic and surgical practices for paediatric scoliosis surgery. Anaesth Intensive Care. 2010;38:1077–1084.
    1. Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005;95:584–591. doi: 10.1093/bja/aei227.
    1. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7:3–9. doi: 10.1007/s11832-012-0457-4.
    1. Rose JB, Watcha MF. Postoperative nausea and vomiting in paediatric patients. Br J Anaesth. 1999;83:104–117. doi: 10.1093/bja/83.1.104.
    1. Cassady JF, Jr., Lederhaas G, Cancel DD, Cummings RJ, Loveless EA. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med. 2000;25:246–253.
    1. Eschertzhuber S, et al. Comparison of high- and low-dose intrathecal morphine for spinal fusion in children. Br J Anaesth. 2008;100:538–543. doi: 10.1093/bja/aen025.
    1. De Oliveira GS, Jr., Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013;116:58–74. doi: 10.1213/ANE.0b013e31826f0a0a.
    1. Apfel CC, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–2451. doi: 10.1056/NEJMoa032196.
    1. Busoni P, Crescioli M, Agostino R, Sestini G. Vomiting and common paediatric surgery. Paediatr Anaesth. 2000;10:639–643. doi: 10.1111/j.1460-9592.2000.00599.x.
    1. Schimmer B. P, Parkel, K. In Goodman & Gilman’s The Pharmacological Basis of Therapeutics (ed. Brunton LL) Ch. 59, 1594 (McGRAW-HILL, 2006).
    1. Nielsen RV, et al. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery: a randomized, blinded, placebo-controlled trial. Pain. 2015;156:2538–2544. doi: 10.1097/j.pain.0000000000000326.
    1. Hermans V, De Pooter F, De Groote F, De Hert S, Van der Linden P. Effect of dexamethasone on nausea, vomiting, and pain in paediatric tonsillectomy. Br J Anaesth. 2012;109:427–431. doi: 10.1093/bja/aes249.
    1. Muhly, W. T. et al. Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis. Pediatrics137 (2016).
    1. Tien M, et al. The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study. Anaesthesia. 2016;71:1037–1043. doi: 10.1111/anae.13544.
    1. Elston MS, et al. Duration of cortisol suppression following a single dose of dexamethasone in healthy volunteers: a randomised double-blind placebo-controlled trial. Anaesth Intensive Care. 2013;41:596–601.
    1. Toner AJ, Ganeshanathan V, Chan MT, Ho KM, Corcoran TB. Safety of Perioperative Glucocorticoids in Elective Noncardiac Surgery: A Systematic Review and Meta-analysis. Anesthesiology. 2017;126:234–248. doi: 10.1097/ALN.0000000000001466.
    1. Corcoran T, et al. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX) Br J Anaesth. 2017;118:190–199. doi: 10.1093/bja/aew446.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa