Gomez-Hernandez, J., Orozco-Alatorre, A.L., Dominguez-Contreras, M., Oceguera-Villanueva, A., Gomez-Romo, S., Alvarez Villaseñor, A.S., . . . Gonzalez-Ojeda, A. (2010). Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer. BMC Cancer, 10, 692.

To evaluate the effectiveness of preoperative dexamethasone in reducing postoperative nausea, vomiting, and pain after mastectomy

Patients were randomized to receive either IV dexamethasone 8 mg or placebo 60 minutes prior to skin incision. All patients had the same standardized general anesthesia. The same surgical team performed each surgery. Pain was assessed on entry to the recovery room and at 6, 12, and 24 hours postoperatively. Analgesia was ketorolac 30 mg every 8 hours and IV tramadol infusion 50 mg as backup medication. Patients were followed for up to 30 days after surgery.

• The sample was composed of 70 patients.
• In the placebo group, mean patient age was 49.89 years (SD = 10.58 years). In the dexamethasone group, mean patient age was 50.11 years (SD = 12.37 years).
• All patients were female.
• All patients had breast cancer. In each group, more than 90% underwent radical mastectomy with axillary node dissection.

• Single site
• Inpatient
• Guadalajara, Jalisco, Mexico

Double-blinded placebo-controlled randomized trial

• Visual analog scale, to assess pain
• Four-point ordinal scale (0 = no vomiting, 3 = vomiting), to assess postoperative nausea and vomiting

Compared to patients in the placebo group, those receiving dexamethasone had significantly lower pain scale scores immediately after surgery (p = 0.004), at 6 hours (p < 0.0005), and at 12 hours (p = 0.04). Pain score differences between groups were approximately 1 point at these times. Authors noted no differences between groups at 24 hours after surgery. More patients in the placebo group than in the dexamethasone group required analgesics (p = 0.008), and the mean dose of IV tramadol was lower for those who received dexamethasone (p = 0.03). Incidence of nausea and vomiting was lower with dexamethasone; more patients in the placebo group required antiemetics (p = 0.01)

Compared to preoperative administration of placebo, preoperative administration of dexamethasone was associated with less short-term postoperative pain, nausea, and vomiting.

• The study had a small sample size, with fewer than 100 participants.
• Patients with a history of motion sickness and other risk factors for nausea and vomiting were excluded from the study, so patients included were those at lower risk for these problems.
• Authors did not report actual intake of opioid or analgesic.

Findings suggest that preoperative dexamethasone administration can reduce short-term postoperative pain, nausea, and vomiting. In this study patients received specific anesthesia regimens. Findings may not be the same with different anesthetics. Further study in this area should identify optimal management of postoperative symptoms. The administration of a single corticosteroid dose prior to surgery can be a relatively low-risk intervention that seems to improve the patient’s experience.