Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer

<p>Abstract</p> <p>Background</p> <p>Dexamethasone has been reported to reduce postoperative symptoms after different surgical procedures. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative nausea and vomiting (PONV), and pain after mastectomy.</p> <p>Methods</p> <p>In this prospective, double-blind, placebo-controlled study, 70 patients scheduled for mastectomy with axillary lymph node dissection were analyzed after randomization to treatment with 8 mg intravenous dexamethasone (<it>n </it>= 35) or placebo (<it>n </it>= 35). All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain score were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.</p> <p>Results</p> <p>Demographic and medical variables were similar between groups. The incidence of PONV was lower in the dexamethasone group at the early postoperative evaluation (28.6% <it>vs</it>. 60%; <it>p </it>= 0.02) and at 6 h (17.2% <it>vs</it>. 45.8%; <it>p </it>= 0.03). More patients in the placebo group required additional antiemetic medication (21 <it>vs</it>. 8; <it>p </it>= 0.01). Dexamethasone treatment significantly reduced postoperative pain just after surgery (VAS score, 4.54 ± 1.55 <it>vs</it>. 5.83 ± 2.00; <it>p </it>= 0.004), at 6 h (3.03 ± 1.20 <it>vs</it>. 4.17 ± 1.24; <it>p </it>< 0.0005) and at 12 h (2.09 ± 0.85 <it>vs</it>. 2.54 ± 0.98; <it>p </it>= 0.04). Analgesics were required in more patients of the control group (21 <it>vs</it>. 10; <it>p </it>= 0.008). There were no adverse events, morbidity or mortality.</p> <p>Conclusions</p> <p>Preoperative intravenous dexamethasone (8 mg) can significantly reduce the incidence of PONV and pain in patients undergoing mastectomy with axillary dissection for breast cancer.</p> <p>Trial registration number</p> <p>NCT01116713</p