The Effects of Single-Dose Preoperative Intravenous Dexamethasone on Clinical Outcome after Laparoscopic Cholecystectomy
Vichit Viriyaroj MD*, Thana Boonsinsukh MD*, Thammanij Rookkachart MD*, Narongchai Yigsakmongkol MD*
Affiliation : * Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background : Laparoscopic cholecystectomy is one of the most common procedures in surgery. Post-operative pain and post-
operative nausea and vomiting (PONV) are frequently events after laparoscopic cholecystectomy and cause distress to
patients. Dexamethasones are known for analgesic, anti-inflammatory, immune-modulating and anti-emetic effects. Therefore,
preoperative dexamethasone administration may reduce postoperative pain and postoperative nausea vomiting after
laparoscopic cholecystectomy.
Objective : This study aims to determine the effects of single-dose preoperative intravenous dexamethasone on clinical
outcome such as postoperative pain nausea and vomiting in patients undergoing laparoscopic cholecystectomy.
Material and Method: This is a prospective randomized controlled trial study. Eighty patients undergoing elective laparoscopic
cholecystectomy were randomized to dexamethasone group and control group. Dexamethasone group received 8 mg (2 ml)
of intravenous dexamethasone 60-90 minute before surgery whereas control group received 2 ml of normal saline 60-90
minute before surgery. Patients received a similar standardized anesthesia, surgical and multimodal analgesic treatment. The
pain score, nausea and vomiting at 1, 6, 24 hours after surgery and before discharge including analgesic consumption and
antiemetic required was recorded in both groups. Preoperative and postoperative erythrocyte sedimentation rate (ESR) and
C-reactive protein (CRP) were measured.
Results : No significant difference existed between two groups regarding age, sex, previous operation, operation time and
hospital stays. All of the patients had no postoperative complication. Postoperative pain score, nausea and vomiting at 1st and
6th hours in dexamethasone group were significantly reduced in comparison with control group. Analgesic consumption,
antiemetic requirement and CRP postoperative were significantly decreased in dexamethasone group.
Conclusion : Single-dose preoperative dexamethasone 8 mg 60-90 minute before induction of anesthesia improved clinical
outcome in terms of significantly less nausea, vomiting, pain at first 6 hours and less inflammatory response after laparoscopic
cholecystectomy compared to placebo. The preoperative dexamethasone should be used as routine in patients undergoing
laparoscopic cholecystectomy.
Keywords : Dexamethasone, Laparoscopic cholecystectomy
