Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS)

Abstract

BackgroundPostoperative nausea and vomiting is one of the most common complications affecting patients after surgery and causes significant morbidity and increased length of hospital stay. It is accepted that patients undergoing surgery on the bowel are at a higher risk. In the current era of minimally invasive colorectal surgery combined with enhanced recovery, reducing the incidence and severity of postoperative nausea and vomiting is particularly important. Dexamethasone is widely, but not universally used. It is known to improve appetite and gastric emptying, thus reduce vomiting. However, this benefit is not established in patients undergoing bowel surgery, and dexamethasone has possible side effects such as increased risk of wound infection and anastomotic leak that could adversely affect recovery.DesignDREAMS is a phase III, double-blind, multicenter, randomized controlled trial with the primary objective of determining if preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing elective gastrointestinal resections. DREAMS aims to randomize 1,350 patients over 2.5 years.Patients undergoing laparoscopic or open colorectal resections for malignant or benign pathology are randomized between 8 mg intravenous dexamethasone and control (no dexamethasone). All patients are given one additional antiemetic at the time of induction, prior to randomization. Both the patient and their surgeon are blinded as to the treatment arm.Secondary objectives of the DREAMS trial are to determine whether there are other measurable benefits during recovery from surgery with the use of dexamethasone, including quicker return to oral diet and reduced length of stay. Health-related quality of life, fatigue and risks of infections will be investigated.Trial registrationISRCTN21973627

Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial

“…PONV is a common complication affecting surgical patients [20]. Untreated PONV can increase the risk of some post-operative complications, such as gastric aspiration, bleeding, wound dehiscence, dehydration, and electrolyte disturbances [21].…”

Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial)

“… Ethical approval: The protocol 37 was approved by the national research ethics committee (NRES No 10/H0402/7) and the Medicines and Healthcare Regulatory Authority (MHRA). …”

Risk factors for postoperative nausea and vomiting after thoracoscopic pulmonary wedge resection: pitfalls of an increased fentanyl dose

“…In recent reports, the overall incidence of PONV was 13-26% (8,16,17). PONV can cause delayed recovery and life-threatening complications such as hospital-acquired pneumonia and thromboembolic events (18). More recent studies have described the effectiveness of preventing PONV; however, this is difficult to clarify in further detail during lung surgery (6,7).…”

“…Considering that antiemetics with a sedative effect increases the risk of failure in our early mobilization protocol, we could not include this into our protocol. Dexamethasone was recommended as an antiemetic, but this is also not covered by insurance in some countries (5,18). There is a gap between the current guidelines and clinical practice.…”