Dexamethasone Reduces Nausea and Vomiting but not Pain after Thyroid Surgery: A Meta-Analysis of Randomized Controlled Trials
Bo Li, Huixia Wang
Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan, China (mainland)
Med Sci Monit 2014; 20:2837-2845
Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. The aim of this article was to evaluate the efficacy of dexamethasone for prevention of PONV and pain in patients undergoing thyroidectomy.
Material and Methods: We performed this meta-analysis based on the QUORUM (Quality of Reporting of Meta-analyses) guidelines. Our study included randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence and severity of PONV, and the secondary outcomes included pain, use of analgesics, and steroid-related complications.
Results: Seven RCTs were included, with a total of 611 patients. A statistically and clinically significant difference in the incidence and severity of PONV was found in favor of dexamethasone (SMD, 0.23; 95% CI, 0.13–0.41; P<0.00001; SMD, 0.53; 95% CI, –1.03 to –0.03; P=0.04). However, there was no significant difference in reduction of pain severity and analgesic consumption in using dexamethasone (SMD, –0.83; 95% CI, –1.85 to 0.18; P=0.14; SMD, –0.19; 95% CI, –0.43 to 0.04; P=0.10). No steroid-related complications were noted.
Conclusions: A single preoperative administration of dexamethasone reduced the incidence and severity of PONV but not pain severity and analgesic consumption in patients undergoing thyroidectomy. Further studies with a larger sample size are needed to further explore the efficacy of dexamethasone on postoperative pain severity and analgesic consumption.
Keywords: Analgesics - therapeutic use, Case-Control Studies, Dexamethasone - therapeutic use, Incidence, Pain, Postoperative - drug therapy, Postoperative Nausea and Vomiting - epidemiology, Publication Bias, Randomized Controlled Trials as Topic, Thyroid Gland - surgery