Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia

Abstract

BackgroundPain after laparoscopy is multifactorial and different treatments have been proposed to provide pain relief. Multimodal analgesia is now recommended to prevent and treat post-laparoscopy pain. Dexamethasone is effective in reducing postoperative pain. The timing of steroid administration seems to be important. We evaluated the analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during laparoscopic cholecystectomy with multimodal analgesia.MethodsOne hundred twenty patients aged 20 to 65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the group N received normal saline 1 hour before induction and after the resection of gall bladder. The patients in the group S1 received dexamethasone 8 mg 1 hour before induction and normal saline after the resection of gall bladder. The patients in the group S2 received normal saline 1 hour before induction and dexamethasone 8 mg after the resection of gall bladder.ResultsVAS scores of group S1 and S2 were lower than that of group N during 48 hours after laparoscopic cholecystectomy. There were no significant differences of VAS scores between the group S1 and the group S2. The analgesic consumption of group S1 and S2 were significantly lower than that of group N.ConclusionsA single dose of dexamethasone (8 mg) intravenously given 1 hour before induction or during operation was effective in reducing postoperative pain after laparoscopic cholecystectomy with multimodal analgesia. The analgesic efficacy of preoperative intravenous dexamethasone 1 hour before versus during surgery was not significantly different.

Preoperative dexamethasone reduce postoperative pain and analgesic consumption in patient undergoing laparoscopic cholecystectomy

“…The results are similar with studies conducted by Fukami et al [8] and Lim et al [9] The mechanism of pain relief by dexamethasone is mainly provided by peripheral suppression of phospolipase enzyme, thereby significantly decreasing the products of cyclooxygenase and lipooxygenase pathways in the inflammatory response [8,10]. Additionally dexamethasone reduced bradykinin which reinforces pain in the inflamed tissues and operated area, and also the decreased concentration of nerve proteins secreted from the peripheral nerve system are involved in the analgesic effect [11].…”

“…With use of steroids complication such as delays recovery, postoperative infection, glucose intolerance and gastric mucosa ulcer can occur [9]. Sauerland et al [16] reported in their meta analysis that there was no significant increase in complications when they used 15-30 mg.kg -1 of methylprednisolone in one dose which is fifty times the amount of dexamethasone used in our study.…”

“…The timings of steroid administration is important to reducing postoperative pain, as initiation of its biological effect is one or two hour of its injection [14]. The dose of dexamethasone 8mg one hour before induction was based on previous reports showing a decrease in postoperative pain [9,15].…”

Does dexmedetomidine reduce postoperative pain after laparoscopic cholecystectomy with multimodal analgesia?

“…There is a report that giving local anesthetic [9], removing residual carbon dioxide [8], preemptive analgesia [10] and dexamethasone [3] are effective and recently multimodal analgesia using all of methods written above is recommended because it is more effective [3]. We reported that such multimodal analgesic method was effective for postlaparoscopic pain control [4]. …”

“…In this study, multimodal analgesia consisted of incisional local anesthetics, NSAID, dexamethasone, removing residual carbon dioxide, and postoperative opioid. We reported that such multimodal analgesic methods were effective for post-laparoscopic pain control [4]. …”