Objective
Dexamethasone is a corticosteroid with minimal side effects that may improve quality
of recovery. We sought to evaluate standard use of this medication prior to vaginal
reconstructive surgery.
Study Design
This was a double-blind, randomized, placebo-controlled trial of women undergoing
vaginal reconstructive surgery for pelvic organ prolapse. Patients scheduled for an
intraperitoneal vaginal vault suspension, with general anesthesia and an overnight
stay, were enrolled. The intervention arm received dexamethasone 60 minutes prior
to surgery, and controls received placebo. Postoperative pain medications, antiemetics,
and voiding trials were standardized. Our primary outcome was the difference in Quality
of Recovery (QoR-40) scores on postoperative day 1. Secondary measures included Postoperative
Nausea and Vomiting Intensity scores, and visual analog scales for nausea/vomiting,
and pain. Our power calculation demonstrated 31 subjects in each group would be necessary
to document difference in QoR-40 scores; to allow for attrition, a goal of 74 subjects
was set.
Results
Seventy-four women were enrolled and randomized. Two withdrew, 9 were excluded, and
63 were analyzed (36 placebo, 27 dexamethasone). The mean age was 63 years. No significant
differences were noted among demographics other than American Society for Anesthesiologists
class; there were greater numbers of dexamethasone subjects that were class 3 (5 vs
11; P = .030). Postoperatively, more patients in the placebo group required promethazine
as a rescue antiemetic for control of their nausea/vomiting (11 vs 2; P = .029). Placebo subjects also failed their voiding trials more frequently, which
remained following a logistic regression controlling for suburethral sling (30 vs
15; P = .037). Regarding the QoR-40 following surgery, the emotional state domain declined
less in dexamethasone patients (–14.3, interquartile range [IQR], 16.8 vs –4.6, IQR,
20.1; P = .042), indicating better symptoms. Whereas pain scales were similar, the visual
analog scales for nausea/vomiting was lower in dexamethasone subjects (0.7; IQR, 4.1
vs 0.4; IQR, 1.4; P = .042). Postoperative Nausea and Vomiting Intensity scores were not significantly
different; nevertheless, twice as many placebo subjects had severe range symptoms
(4 vs 2; P = .47). No adverse effects from the dexamethasone were noted.
Conclusion
Use of dexamethasone prior to vaginal reconstructive surgery was associated with less
nausea/vomiting and need for antiemetics as well as greater success with voiding trials.
Furthermore, quality of recovery was enhanced, suggesting use of dexamethasone should
be considered for these patients.
Key words
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Article info
Publication history
Published online: May 29, 2015
Accepted:
May 28,
2015
Received in revised form:
April 16,
2015
Received:
December 19,
2014
Footnotes
The authors report no conflict of interest.
Cite this article as: Pauls RN, Crisp CC, Oakley SH, et al. Effects of dexamethasone on quality of recovery following vaginal surgery: a randomized trial. Am J Obstet Gynecol 2015;213:718.e1-7.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
