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The Impact of Intraoperative Dexamethasone and Mannitol on Postoperative Inflammatory Response in Totally Tubeless
Ehsan Zemanati Yar1, Iman Menbari Oskouie1, Abdolreza Mohammadi1
1Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran, tums.ac.ir.
Background And Aims:
Dexamethasone, a corticosteroid, reduces inflammation, while mannitol, a diuretic, improves renal blood flow and stone clearance. This study examines the impact of dexamethasone and mannitol during surgery on infection rates, pain control, and analgesic needs in totally tubeless PCNL (TTPCNL) patients.
Methods:
This double-blind, controlled clinical trial at a single center involved 121 patients undergoing TTPCNL. Participants were randomly divided into four groups: control, dexamethasone, mannitol, and dexamethasone-mannitol (DM). Postoperative outcomes included pain intensity measured using the visual analog scale (VAS) at 6 and 24 hours after tubleless PCNL. Patients with moderate-to-severe pain received rescue analgesia (paracetamol and ketorolac). Additional outcomes included length of hospital stay (LOS), serum interleukin-6 (IL-6) levels, gross hematuria, stone-free rate (SFR), Clavien-Dindo grade (CDG), and postoperative complications, including sepsis, systemic inflammatory response syndrome (SIRS), hemoglobin decline, the need for angiography, hospital readmission, and acute kidney injury (AKI).
Results:
This study included 81 male participants (66.9%), with a mean age of 50.9 ± 12.2 years. Patients treated with dexamethasone, either alone or with mannitol, showed significant reductions in postoperative SIRS (p value < 0.001), hemoglobin drop (p value < 0.001), hospital stay duration (p value < 0.001), CDG (p value < 0.001), postoperative pain (p value < 0.001), and analgesic use (p value = 0.015). IL-6 levels in DM group were significantly lower compared to others (p = 0.002). There were no significant reductions in occurrence of AKI, readmission, angiography, sepsis, and SFR.
Conclusions:
The intraoperative use of dexamethasone and mannitol during TTPCNL effectively mitigated postoperative inflammatory responses. This was achieved by reducing levels of IL-6 and decreasing the occurrence of SIRS. Additionally, patients experienced a shorter postoperative hospital stay, lower VAS pain score, lower CDG, and lower analgesic consumption. Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20190305042939N1.