Dexamethasone facilitates discharge after outpatient anorectal surgery

Margarita Coloma, Larry L. Duffy, Paul F. White, W. Kendall Tongier, Philip J. Huber

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Corticosteroids can decrease pain and postoperative nausea and vomiting after ambulatory surgery. Therefore, we designed a study to evaluate if the routine use of dexamethasone would facilitate the early recovery process after anorectal surgery. A secondary aim of the study was to determine if dexamethasone would increase the incidence of postoperative wound complications. Eighty adult outpatients undergoing anorectal surgery with a standardized monitored anesthesia care technique were randomly assigned to receive either dexamethasone 4 mg IV or an equal volume of saline before the start of surgery. All patients were premedicated with midazolam 2 mg IV and received ketorolac 30 mg IV as a preemptive analgesic. A propofol infusion, 50 μg · kg-1 · min-1 IV, was initiated and subsequently titrated to maintain an observer's assessment of alertness/sedation score of 2 or 3 (with 5 = awake/alert to 1 = asleep). Fentanyl 25 μg IV was administered 3-5 min before infiltrating the surgical field with a 30-mL local anesthetic mixture containing 15 mL of lidocaine 1% and 15 mL of bupivacaine 0.25% (with epinephrine 1:200,000 and sodium bicarbonate 3 mL). All patients were fast-tracked directly from the operating room to the step-down recovery area. Even though the incidences of postoperative pain and postoperative nausea and vomiting were small in both treatment groups, the time to "home readiness" was significantly shorter in the dexamethasone group. Importantly, there was no increase in the incidence of wound infections (8% vs 12%) or hematoma formation (3% vs 5%) in the dexamethasone (versus saline) group. We conclude that the administration of dexamethasone, 4 mg IV, shortened the time to home readiness without increasing the incidence of postoperative wound infections in a high-risk outpatient population undergoing anorectal surgery.

Original languageEnglish (US)
Pages (from-to)85-88
Number of pages4
JournalAnesthesia and Analgesia
Volume92
Issue number1
StatePublished - 2001

Fingerprint

Ambulatory Surgical Procedures
Dexamethasone
Postoperative Nausea and Vomiting
Incidence
Outpatients
Ketorolac
Surgical Wound Infection
Sodium Bicarbonate
Midazolam
Bupivacaine
Fentanyl
Propofol
Wound Infection
Operating Rooms
Postoperative Pain
Lidocaine
Local Anesthetics
Hematoma
Epinephrine
Analgesics

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Coloma, M., Duffy, L. L., White, P. F., Tongier, W. K., & Huber, P. J. (2001). Dexamethasone facilitates discharge after outpatient anorectal surgery. Anesthesia and Analgesia, 92(1), 85-88.

Dexamethasone facilitates discharge after outpatient anorectal surgery. / Coloma, Margarita; Duffy, Larry L.; White, Paul F.; Tongier, W. Kendall; Huber, Philip J.

In: Anesthesia and Analgesia, Vol. 92, No. 1, 2001, p. 85-88.

Research output: Contribution to journalArticle

Coloma, M, Duffy, LL, White, PF, Tongier, WK & Huber, PJ 2001, 'Dexamethasone facilitates discharge after outpatient anorectal surgery', Anesthesia and Analgesia, vol. 92, no. 1, pp. 85-88.
Coloma, Margarita ; Duffy, Larry L. ; White, Paul F. ; Tongier, W. Kendall ; Huber, Philip J. / Dexamethasone facilitates discharge after outpatient anorectal surgery. In: Anesthesia and Analgesia. 2001 ; Vol. 92, No. 1. pp. 85-88.
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