The Association between Intraoperative Single-Dose Dexamethasone and Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

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Hatfield, Sara
cholecystectomy; dexamethasone; laparoscopic; opioids; pain; postoperative; Anesthesiology; Medical Specialties; Medicine and Health Sciences; Nursing
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Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively with postoperative pain in patients undergoing laparoscopic cholecystectomy surgery. Dexamethasone is safe to use intraoperatively and when given as a single dose, has minimal side effects.Methodology: The design chosen for this research study was a retrospective, quantitative, case-control design. Data collection was conducted by using patient EMR’s from CAMC. Data were obtained from patients ages 18-64 years who underwent outpatient laparoscopic cholecystectomy surgery requiring general anesthesia from June 15, 2007, to June 15, 2017. There were a total of 200 patients selected from the 5,700 charts that met the inclusion and exclusion criteria. The sample consisted of a case group (N=100) of patients who received an intraoperative 4-8 mg single dose of dexamethasone. The control group (N=100) consisted of patients who did not receive dexamethasone intraoperatively. Variables of age, gender, ASA physical classification status, BMI, LOS, dexamethasone dose, VAS pain scores on admission and VAS pain scores on discharge from the PACU, and total intraoperative and postoperative opioid administration in morphine equivalents were collected. A p-value of < .05 was considered significant.Results: Comparison between the two groups showed no difference in mean age, BMI, ASA physical status, gender, LOS, or VAS pain scores on discharge from the PACU (p > .05). There was no association between the administration of dexamethasone intraoperatively and VAS pain scores on admission to or discharge from the PACU or total PACU opioid consumption (p > .05). An association was found between VAS pain scores on admission to the PACU and age (p = .004). An association was also found between VAS pain scores on discharge from the PACU and gender (p = .007) and ASA physical status (p = .041). Additionally, an association was found between total PACU opioid consumption and age (p = .010), female gender (p = .002), and ASA physical status (p = .026).Conclusion: The administration of a single 4-8 mg dose of dexamethasone intraoperatively was not associated with lower VAS pain scores upon admission or discharge from the PACU or total PACU opioid consumption in patients undergoing laparoscopic cholecystectomy in the outpatient setting.Implications/Recommendations: This research study did not support the association between the use of dexamethasone and reduced postoperative pain. Studies have proven the efficacy of dexamethasone and the reduction of PONV. PONV has also been shown to contribute to the overall discomfort of the patient in the postoperative period. For this reason, the practitioner should still consider using dexamethasone as part of a multimodal approach to patient management. Further research in the form of a randomized, prospective study should be implemented that could control factors such as the surgeon performing the procedure and anesthetic technique.