High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial.
Eur J Cardiothorac Surg
; 53(1): 209-215, 2018 Jan 01.
Article
em En
| MEDLINE
| ID: mdl-28977390
ABSTRACT
OBJECTIVES:
The optimal postoperative analgesic strategy after video-assisted thoracoscopic surgery lobectomy remains undetermined. We hypothesized that high-dose preoperative methylprednisolone (MP) would improve analgesia compared to placebo.METHODS:
A total of 120 adult patients were randomized equally to 125 mg MP or placebo before the start of their elective video-assisted thoracoscopic surgery lobectomy. Group allocation was blinded to patients, investigators and caregivers, and all patients received standardized multimodal, opioid-sparing analgesia. Our primary outcome was area under the curve on a numeric rating scale from 0 to 10, for pain scores on the day of surgery and on postoperative days 1 and 2. Clinical follow-up was 2-3 weeks, and telephone follow-up was 12 weeks after surgery.RESULTS:
Ninety-six patients were included in the primary analysis. Methylprednisolone significantly decreased median pain scores on the day of surgery at rest (numeric rating scale 1.6 vs 2.0, P = 0.019) and after mobilization to a sitting position (numeric rating scale 1.7 vs 2.5, P = 0.004) but not during arm abduction and coughing (P = 0.052 and P = 0.083, respectively). Nausea and fatigue were reduced on the day of surgery (P = 0.04 and 0.03), whereas no outcome was improved on postoperative Days 1 and 2. Methylprednisolone did not increase the risk of complications but increased blood glucose levels on the day of surgery (P < 0.0001).CONCLUSIONS:
High-dose preoperative MP significantly reduced pain at rest and after mobilization to a sitting position on the day of surgery, without later analgesic effects. Nausea and fatigue were improved without side effects, except transient higher postoperative blood glucose levels. CLINICAL TRIAL REGISTRATION Registered at clinicaltrialsregister.eu [7 November 2012, EudraCT 2012-004451-37; https//www.clinicaltrialsregister.eu/ctr-search/trial/2012-004451-37/DK].Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Dor Pós-Operatória
/
Pneumonectomia
/
Metilprednisolona
/
Cirurgia Torácica Vídeoassistida
/
Anti-Inflamatórios
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur J Cardiothorac Surg
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Dinamarca