Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery

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Abstract

Background

Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery.

Methods

This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg−1 or dexamethasone 0.1 mg kg−1 before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated.

Results

Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg−1 193 (192–195) was greater than dexamethasone 0.05 mg kg−1 179 (175–185) (P=0.004) or saline, 171 (160–182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (0–6.3) mg after dexamethasone 0.1 mg kg−1 compared with 5.3 (2.4–8.8) mg and 5.3 (2.7–7.8) mg after dexamethasone 0.05 mg kg−1 and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg−1 compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg−1 had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg−1 and saline.

Conclusions

Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg−1 reduced opioid consumption compared with dexamethasone 0.05 mg kg−1, which may be beneficial for improving recovery after ambulatory gynaecological surgery.

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