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Dexamethasone Dose and Early Postoperative Recovery after Mastectomy: A Double-blind, Randomized Trial
Kristin Julia Steinthorsdottir1, Hussein Nasser Awada, Hanne Abildstrøm
1From the Department of Anesthesiology, Centre for Cancer and Organ Diseases (K.J.S., H.N.A., E.K.A.) Surgical Pathophysiology Unit (K.J.S., H.K.) Department of Anesthesiology, Centre of Head and Orthopaedics (H.A.), Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark Department of Breast Surgery, Herlev/Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.K.).
Higher doses of preoperative dexamethasone (24 mg) did not improve early recovery after mastectomy compared to lower doses (8 mg). Both regimens resulted in low pain and nausea, with no significant difference in hospital stay, but a higher incidence of seroma with the higher dose.
Area of Science:
- Anesthesiology
- Surgical Recovery
- Pharmacology
Background:
- Postoperative pain and nausea are common after mastectomy.
- Multimodal analgesia, including preoperative glucocorticoids, can aid recovery.
- Dexamethasone is a glucocorticoid used to manage postoperative complications.
Purpose of the Study:
- To compare the efficacy of 24 mg versus 8 mg of preoperative dexamethasone in enhancing early recovery after mastectomy.
- To evaluate the impact of different dexamethasone doses on pain, nausea, and other recovery parameters.
Main Methods:
- A randomized, double-blind trial involving patients undergoing mastectomy.
- Patients received either 24 mg or 8 mg of dexamethasone preoperatively.
- Standardized anesthesia, analgesia (acetaminophen), and wound care were administered to all participants.
Main Results:
- No significant difference was observed in the primary outcome (meeting discharge criteria) between the 24 mg and 8 mg dexamethasone groups (35% in each).
- The 24 mg group showed a higher incidence of seroma requiring drainage (94%) compared to the 8 mg group (81%).
- Both groups reported low pain scores and similar low rates of nausea; median hospital stay was slightly longer in the 24 mg group.
Conclusions:
- Preoperative dexamethasone at 24 mg did not offer superior early recovery benefits compared to 8 mg after mastectomy.
- The study highlights the effectiveness of a simple analgesic protocol in achieving low pain scores and short hospital stays.
- Higher dexamethasone doses may increase the risk of seroma formation, warranting careful consideration in clinical practice.
