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Eur J Cardiothorac Surg. 2018 Jan 1;53(1):209-215. doi: 10.1093/ejcts/ezx248.

High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial.

Author information

1
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen East, Denmark.
2
Department of Cardiothoracic Anaesthesia, Rigshospitalet, Copenhagen University, Copenhagen East, Denmark.
3
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen East, Denmark.

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].

KEYWORDS:

Methylprednisolone; Pain; Postoperative; Steroids; Video assisted thaoracic surgery

Comment in

PMID:
28977390
DOI:
10.1093/ejcts/ezx248
[Indexed for MEDLINE]

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