Systematic review on the efficacy and safety of dexamethasone in laparoscopic abdominal surgery: a comprehensive review

Le résumé fourni par la source

There is a constant quest to optimize outcomes of laparoscopic surgery and enhance patient experiences. In this review, we aim to describe the various impacts of dexamethasone in laparoscopic abdominal surgery. A systemic review of randomized controlled trials was performed in accordance with the PRISMA checklist, and the protocol was published in the electronic library (PROSPERO) with a search Accepted manuscript ACCEPTED MANUSCRIPT in Embase, Medline and Cochrane Library. Risk of bias was assessed according to the principles from Rob2. The review includes mainly cholecystectomies (n=26) and, in descending order, major gynecological surgery (n=10), gastric bypass (n=2), fundoplication (n=1), appendectomy (n=1), and inguinal hernia (n=1). The trials were all moderate-good quality providing evidence on postoperative nausea and vomiting while the (often secondary) outcomes on surgical stress markers were classified with a risk of bias from green to yellow according to RoB 2. All 41 studies except for seven reported as primary outcome on postoperative nausea and vomiting. In cholecystectomies, 85% found an ameliorating effect on postoperative nausea and vomiting, like all trials in gynecological surgery with doses of just 4-8 mg dexamethasone. Less postoperative pain was stated in six of 26 cholecystectomy trials; two of these specified an opioid sparing effect. Similarly, reduced postoperative pain was found in three of ten trials in gynecological surgery. No pain reduction was seen in surgery lasting shortly and when administering dexamethasone just before the start of the operation. None of the trials found any difference in postoperative infectious complications, wound complications, or other adverse effects. Patients undergoing surgery show less postoperative nausea and vomiting with dexamethasone while lower pain scores were not reported routinely. Our present review points to limited analgesic effect of dexamethasone in low to medium dose in laparoscopic cholecystectomy.

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