In a 2017 trial, researchers sought to determine the efficacy of an 8 mg dexamethasone injection prior to bowel surgery for reducing nausea and vomiting post-operation. The findings suggest dexamethasone reduces nausea and vomiting after bowel surgery and shortens the time taken to restart eating.
Nausea and vomiting are associated with slower recovery and a higher risk of malnutrition in patients who have undergone gastrointestinal surgery. Though the antiemetic (anti-nausea and vomiting drug) dexamethasone has been shown to be effective for reducing post-operative nausea and vomiting (PONV) for a number of operations, its benefit in small and large bowel surgery is unproven. If found to be safe and effective, the use of dexamethasone in bowel surgery could improve patient recovery, prevent operation-associated malnutrition, and reduce surgery-related complications.
In a 2017 study published in the British Medical Journal, researchers sought to determine whether taking dexamethasone after gastrointestinal surgery reduces vomiting. Adult patients undergoing elective open or minimally-invasive bowel surgery were recruited. Those who were pregnant, diabetic, had glaucoma, active stomach ulcers, or high blood sugar, who were on systemic steroid-based medications, or who were allergic to dexamethasone were excluded. Patients received either a standard antiemetic (the control group) or a standard antiemetic and one 8 mg dose of intravenous dexamethasone (the dexamethasone group) before surgery. All patients were anesthetized and no other antiemetics were administered during the operations. After surgery, antiemetics were administered upon patients’ requests. Only standard antiemetics were available within the first 24 hours post-surgery, after which point dexamethasone became available. Patients were unaware of which antiemetic they received before or following surgery.
Efficacy was assessed based on the presence of any vomiting episodes within the first 24 hours; the number of vomiting episodes and the use of post-operation antiemetics reported within the first 24 hours, between 25 and 72 hours, and 73 and 120 hours post-operation by staff or patients; the severity of nausea and vomiting, measured on the PONV intensity scale; fatigue, measured using the functional assessment of chronic illness-fatigue (FACIT-F) questionnaire; the time taken to tolerate food and the length of the hospital stay; and health-related quality of life, measured using the EQ-5D-3L questionnaire. After 30 days, patients were assessed for any complications.
In total, 1,350 participants were recruited between July 2011 and January 2014: 674 were assigned to the dexamethasone group and 676 were assigned to the control group. Most (63%) procedures were minimally invasive. Five dexamethasone patients were only administered a standard antiemetic, 10 control patients received dexamethasone, and 4% of participants did not receive a standard antiemetic before surgery. After surgery, 55 (8%) in the dexamethasone group and 134 (20%) in the control group received more than 1 antiemetic.
Vomiting within the first 24 hours was experienced by 395 participants (29.3%): 172 dexamethasone patients (25.5% of the dexamethasone group) and 223 control patients (33.2% of the control group). Essentially, 1 in every 13 patients given dexamethasone before surgery was spared vomiting within the first 24 hours. The number of vomiting episodes did not differ significantly between groups between 25 and 72 or 73 and 120 hours post-operation. Antiemetics were given to 265 (39.3%) in the dexamethasone group compared to 351 (51.9%) in the control group between 0 and 24 hours, 353 (52.4%) compared to 425 (62.9%) between 25 and 72 hours, and 276 (40.9%) compared to 285 (42.2%) between 73 and 120 hours. Nausea and vomiting were less severe in the dexamethasone group at 24 hours post-operation, with 54 (8.6%) having clinically important PONV scores compared to 79 (12.7%) in the control group, though no difference between groups was found at 72 or 120 hours. Of those who started fluids by 24 hours, 62.3% of dexamethasone patients compared to 53.1% of control patients had also started eating. Food tolerance was about equal for both groups by 72 hours. EQ-5D-3L and FACIT-F scores were no different between groups at 120 hours or 30 days post-operation. The length of hospitalization was also similar between groups. There were 30 deaths during the trial: 13 (1.9%) dexamethasone patients and 17 (2.5%) control patients. The rate of adverse events was not significantly different between the two groups.
Overall, the findings suggest prior injection with 8 mg of dexamethasone reduces nausea and vomiting after bowel surgery. At 24 hours post-surgery, dexamethasone was found to reduce post-operative nausea and vomiting, requests for antiemetics after surgery, and the time taken to restart eating after the operation. Moreover, dexamethasone was not found to increase the risk of adverse events above that of standard care. Future research may benefit from exploring the efficacy of other doses of dexamethasone and engaging in a more detailed analysis of the effect of dexamethasone on nutrition after bowel surgery.
Written By: Raishard Haynes, MBS