Newly Published
Perioperative Medicine  |   January 2020
Dexamethasone Dose and Early Postoperative Recovery after Mastectomy: A Double-blind, Randomized Trial
Author Notes
  • From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.), Surgical Pathophysiology Unit (K.J.S., H.K.), and Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark; Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K.).
  • Submitted for publication May 31, 2019. Accepted for publication December 11, 2019.
    Submitted for publication May 31, 2019. Accepted for publication December 11, 2019.×
  • Correspondence: Address correspondence to Dr. Steinthorsdottir: Rigshospitalet dep. 2043, Blegdamsvej 9, 2200 Copenhagen, Denmark. kste0050@regionh.dk. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Pain Medicine
Perioperative Medicine   |   January 2020
Dexamethasone Dose and Early Postoperative Recovery after Mastectomy: A Double-blind, Randomized Trial
Anesthesiology Newly Published on January 21, 2020. doi:https://doi.org/10.1097/ALN.0000000000003112
Anesthesiology Newly Published on January 21, 2020. doi:https://doi.org/10.1097/ALN.0000000000003112
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Dexamethasone is an effective antiemetic and may facilitate initial postoperative recovery after mastectomy

  • Whether 24 mg is more effective than 8 mg remains unknown

What This Article Tells Us That Is New:

  • Dexamethasone (24 mg) did not increase the number of patients eligible to skip the postanesthetic care unit

  • Pain scores were low and nausea rare in both groups

  • Dexamethasone (24 mg) was not preferable to 8 mg

Background: Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol.

Methods: In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections.

Results: One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217).

Conclusions: The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.