Premium
CR04
*DOUBLE BLIND RANDOMISED CONTROLLED TRIAL OF THE INFLUENCE OF GLUCOCORTICOIDS ON POST‐OPERATIVE RECOVERY FOLLOWING COLECTOMY
Author(s) -
Zargar Shoshtari K.,
Sammour T.,
Kahokehr A.,
Connolly A. B.,
Hill A. G.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04915_4.x
Subject(s) - medicine , dexamethasone , placebo , randomized controlled trial , nausea , cytokine , vomiting , anesthesia , abdominal surgery , surgery , gastroenterology , alternative medicine , pathology
Post‐operative fatigue (POF) is an important indicator of recovery after major surgery. Recent data have suggested a relationship between the post‐operative peritoneal cytokine response and development of POF. Glucocorticoids decrease the production of cytokines and thus we hypothesised that administration of dexamethasone to patients undergoing colonic surgery may decrease peritoneal cytokine production and POF. Aim: To assess the influence of 8 mg of pre‐op IV Dexamethasone on peritoneal cytokine and POF in patients undergoing elective colonic surgery. Method: In a double blinded RCT, 70 consecutive patients undergoing elective, open colonic resection were administered 8 mg I.V. Dexamethasone or saline (Placebo) prior to surgery. All patients were treated within a structured Enhanced Recovery After Surgery program. Results: After exclusions there were 31 patients in the Placebo group and 29 in the Dex group. At baseline there were no differences in the age, ASA, BMI or CR‐POSSUM scores. Dexamethasone was associated with a significant reduction in Interleukin‐6 (IL‐6) and IL‐13 in the peritoneum and IL‐6 and IL‐8 in plasma. Subsequently, patients in the Dex group had lesser POF and fatigue impact scores at days 3 and 7. Patients in the Dex group had less post‐op nausea and vomiting. There was no significant increase in complications. Conclusion: Preoperative Dexamethasone administration is associated with a significantly diminished post‐operative pro‐inflammatory reaction which is associated with clinical benefits in POF and its impact. This intervention may be an effective method of improving outcomes for patients undergoing major colonic surgery within a multimodal enhanced peri‐operative care pathway.