Most patients surveyed are more worried about nausea and vomiting after surgery and anesthesia than any other common complication. This implies that this problem, while it might seem minor in terms of severity, is the cause of great anxiety and discomfort. While many discussions and studies have focused on the use of various medications to prevent post-operative nausea and vomiting (PONV), the role of steroids such as dexamethasone has not garnered as much attention.

The concept of using steroids for the prevention of PONV is not a new one. In another article on this site (Vomiting Can Be Abolished), a protocol shown to practically eliminate the occurrence of PONV is discussed. The use of the steroid dexamethasone in a dose of 10 milligrams was part of this protocol. Still, even though the concept is not new, many practitioners are hesitant to use steroids on a routine basis for this purpose because of lack of familiarity, or due to doubts about the efficacy of this treatment.

Evidence continues to build, however, that not only is dexamethasone effective for prevention of PONV, but that the side effects associated with a single dose are minor. In addition, the proper dose range is beginning to be clarified.

For example, a recent study by Wang et al. included two hundred and twenty five women undergoing thyroid surgery. Four different dosages (1.25, 2.5, 5 and 10 milligrams) of dexamethasone were compared with placebo. The dexamethasone was given shortly after the induction of general anesthesia. The results showed that PONV was reduced from about 50% in those patients receiving no medication to about 20% in the groups receiving 5 milligrams or 10 milligrams of dexamethasone.

These results are as good as the use of other single agents that are currently utilized for the prevention of PONV. In addition, the cost of dexamethasone is much lower than many of the standard agents in use today. Evidence is also coming out that the use of dexamethasone in combination with other agents probably shows even better results. Since the five milligram dose was just as effective as the ten milligram dose, the authors of the study recommend that the lower dose be used.

The most important concern about the routine use of steroids in this way has been whether wound healing will be affected. It is well known that the use of steroids on a long term basis can seriously affect the ability of the body to heal wounds, etc. However, most physicians believe that a single dose of steroids probably does not have a significant effect. The study mentioned looked at the incidence of delayed wound healing and wound infection in patients and did not find any difference. However, more data in more patients undergoing a more varied range of surgeries is necessary before it can be said that there is definitely no effect.

The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: A dose-ranging study
Wang JJ, Ho ST, Lee SC, Liu YC, Ho CM
Anesth Analg 2000 Dec;91(6):1404-7

 

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