Can intra-operative methylprednisolone application be effective for post-operative pain, nausea and vomiting in laparoscopic cholecystectomy operations? Postoperative effects of methylprednisolone

Ebru  Aladağ; Yücel  Gültekin

doi:10.28982/josam.7554

Authors

Ebru Aladağ Department of Anesthesiology and Reanimation, Uşak University Faculty of Medicine, Uşak, Turkey https://orcid.org/0000-0001-7219-1406
Yücel Gültekin Department of General Surgery, Uşak University Faculty of Medicine, Uşak, Turkey https://orcid.org/0000-0002-1974-1242

DOI:

https://doi.org/10.28982/josam.7554

Keywords:

Methylprednisolone, Postoperative pain, Postoperative nausea-vomiting

Abstract

Background/Aim: Post-operative nausea, vomiting (PONV), and pain are common symptoms after laparoscopic cholecystectomy (LC) that is performed under general anesthesia. These symptoms lead to prolongation of post-operative recovery and hospital stay. In this study, the efficacy of intra-operative methylprednisolone (MP) administration on post-operative pain and PONV was investigated in patients undergoing LC under general anesthesia.

Methods: This study was conducted at Uşak University Faculty of Medicine Hospital. Patients who underwent LC under general anesthesia between 01.11.2018 and 01.06.2019 were evaluated using the prospective cohort method. While intra-operative MP was administered to one group of patients who underwent LC (MP group), MP was not administered to the second group (non-MP). The pain was evaluated using the Visual Analog Scale (VAS) while PONV was evaluated with the Verbal Descriptive Scale (VDS in patients at post-operative hours 0, 1, 2, 6, 12, 18, and 24. On the first post-operative day, patient satisfaction was assessed.

Results: The study cohort consisted of 76 patients. The VAS was used to measure post-operative pain, and it was discovered that the MP group had significantly reduced VAS values at post-operative hours 0, 1, 2, 6, 12, 18, and 24 (P < 0.001). In the VDS evaluation, no difference between the two groups only at post-operative hour 12 (P = 0.52) was found, while the VDS value was found to be lower in the MP group than in the non-MP group at post-operative hours 0, 1, 2, 6, 18, and 24 (P ˂ 0.001). The mean total analgesic use at post-operative hour 48 was 69.08 (26.91) mg in the MP group and 96.71 (42.38) mg in the non-MP group. The difference was statistically significant (P ˂ 0.001).

Conclusion: PONV and discomfort incidence decreased after intra-operative MP
administration. The decrease in these symptoms was positively reflected in post-operative
patient satisfaction.

Downloads

Download data is not yet available.

References

Hill RP, Lubarsky DA, Phillips-Bute B, Fortney T, Creed MR, Glass PS, et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology. 2000 Apr;92(4):958-67. DOI: https://doi.org/10.1097/00000542-200004000-00012

Kaya Z, Kaya S, Ölmez G. The effect of granisetron dexamethasone combination on postoperative nausea and vomiting in gynecological operations Dicle Med J. 2010;37(2):109-14.

Kranke P, Eberhart LH, Toker H, Roewer N, Wulf H, Kiefer P. A prospective evaluation of the POVOC score for the prediction of postoperative vomiting in children. Anesth Analg. 2007 Dec;105(6):1592-7. DOI: https://doi.org/10.1213/01.ane.0000287816.44124.03

Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012 Nov;109(5):742-53. DOI: https://doi.org/10.1093/bja/aes276

Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Ramosetron vs granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 1999 Oct;46(10):991–3. DOI: https://doi.org/10.1007/BF03013138

Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med. 2016 Sep; 176(9):1286-93. DOI: https://doi.org/10.1001/jamainternmed.2016.3298

Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can J Anaesth. 2001 Nov; 48(10):1000-10. DOI: https://doi.org/10.1007/BF03016591

Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002 Nov;195(5):694–712. DOI: https://doi.org/10.1016/S1072-7515(02)01491-6

.Rich WM, Abdulhayoglu G, DiSaia PJ. Methylprednisolone as an antiemetic during cancer chemotherapy – a pilot study. Gynecol Oncol. 1980 Apr;9(2):193–8. DOI: https://doi.org/10.1016/0090-8258(80)90027-X

Gautam S, Agarwal A, Das PK, Agarwal A, Kumar S, Khuba S. Evaluation of the efficacy of methylprednisolone, etoricoxib and a combination of the two substances to attenuate postoperative pain and PONV in patients undergoing laparoscopic cholecystectomy: a prospective, randomized, placebo-controlled trial. Korean J Pain. 2014 Jul;27(3):278–84. DOI: https://doi.org/10.3344/kjp.2014.27.3.278

Lau H, Brooks DC. Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg. 2001 Oct;136(10):1150-3. DOI: https://doi.org/10.1001/archsurg.136.10.1150

Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. 1999 Nov;83(5):772-5. DOI: https://doi.org/10.1093/bja/83.5.772

Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000 Jan;90(1):186–94. DOI: https://doi.org/10.1097/00000539-200001000-00038

Kleif K, Hauge CI, Vilandt J, Gögenur I. Randomized Clinical Trial of Preoperative High-Dose Methylprednisolone on Postoperative Pain at Rest After Laparoscopic Appendectomy. Anesth Analg. 2018 May;26(5):1712-20. DOI: https://doi.org/10.1213/ANE.0000000000002693

Lunn TH, Kristensen BB, Andersen LØ, Husted H, Otte KS, Gaarn-Larsen L, et al. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth. 2011 Feb;106(2):230–8. DOI: https://doi.org/10.1093/bja/aeq333

Lunn TH, Andersen LØ, Kristensen BB, Husted H, Gaarn-Larsen L, Bandholm T, et al. Effect of high-dose preoperative methylprednisolone on recovery after total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. Br J Anaesth. 2013 Jan;110(1):66–73. DOI: https://doi.org/10.1093/bja/aes345

Aabakke AJ, Holst LB, Jørgensen JC, Secher NJ. The effect of a preoperative single-dose methylprednisolone on postoperative pain after abdominal hysterectomy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2014 Sep;180:83–8. DOI: https://doi.org/10.1016/j.ejogrb.2014.06.026

Bashashati M, McCallum RW. Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. Eur J Pharmacol. 2014 Jan;722:79-94. DOI: https://doi.org/10.1016/j.ejphar.2013.09.075

Hargreaves KM, Costello A. Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes. Clin Pharmacol Ther. 1990 Aug;48(2):168–78. DOI: https://doi.org/10.1038/clpt.1990.132

Hong D, Byers MR, Oswald RJ. Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reactions in injured teeth. Pain 1993 Nov;55(2):171–81. DOI: https://doi.org/10.1016/0304-3959(93)90146-G

Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013 Feb;110(2):191–200. DOI: https://doi.org/10.1093/bja/aes431