Effect of a preoperative single-dose steroid on pulmonary function and postoperative symptoms after modified radical mastectomy: results of a randomized clinical trial.

Autor:	Jiménez-Tornero J; San Javier Hospital, Guadalajara, Jalisco, Mexico., Cortés-Flores AO; San Javier Hospital, Guadalajara, Jalisco, Mexico.; ANKER Global Oncology, Guadalajara, Jalisco, Mexico., Chávez-Tostado M; Department of Human Reproduction, Health Sciences University Center, Universidad de Guadalajara, Jalisco, México., Morgan-Villela G; San Javier Hospital, Guadalajara, Jalisco, Mexico., Zuloaga-Fernández Del Valle C; San Javier Hospital, Guadalajara, Jalisco, Mexico.; ANKER Global Oncology, Guadalajara, Jalisco, Mexico., Zuloaga-Fernández Del Valle R; San Javier Hospital, Guadalajara, Jalisco, Mexico.; ANKER Global Oncology, Guadalajara, Jalisco, Mexico., García-González LA; San Javier Hospital, Guadalajara, Jalisco, Mexico., Fernández-Avalos VS; Universitary Center of Tonala, University of Guadalajara, Guadalajara, Mexico., Miranda-Ackerman RC; San Javier Hospital, Guadalajara, Jalisco, Mexico., Alvarez-Villaseñor AS; Medical Auxiliary Coordination of Health Research, Mexican Institute of Social Security, Baja California Sur, Mexico., Ambriz-González G; Surgical Division, Pediatric Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico., Barbosa-Camacho FJ; Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico., Fuentes-Orozco C; Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico., Contreras-Cordero VS; Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico., González-Ojeda A; Biomedical Research Unit 02, Specialties Hospital of the Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
Jazyk:	angličtina
Zdroj:	Gland surgery [Gland Surg] 2020 Oct; Vol. 9 (5), pp. 1313-1327.
DOI:	10.21037/gs-20-366
Abstrakt:	Background: Evidence suggests that a preoperative single-dose steroid improves lung function and decreases the incidence of postoperative symptoms; however, this has not been sufficiently proved in modified radical mastectomy for cancer. This study aimed to evaluate the efficacy of preoperative single-dose steroid administration for postoperative lung function and postoperative symptoms in women undergoing modified radical mastectomy for breast cancer. Methods: In this controlled clinical trial, conducted between June 2014 and October 2018, we examined 81 patients. Patients received a preoperative single dose of 8 mg dexamethasone (n=41; treatment group) or placebo (sterile injectable water; n=40; control group). We obtained data on postoperative nausea and vomiting and pain intensity and performed spirometry 1 h before and 1, 6, 12, and 24 h after surgery. The use of additional analgesic or antiemetic drugs was recorded. We followed up patients 30 days after discharge and recorded any surgical or medical complications. Results: The age distribution and anthropometric variables of the two groups were similar. Almost 50% of the patients in each group also underwent breast reconstruction. In the treatment group, pain intensity was always lower, the incidence of postoperative nausea and vomiting was lower at 6, 12, and 24 h, and additional analgesics or antiemetics were required less frequently (P<0.05 for all). Both treatment and control groups demonstrated a restrictive ventilatory pattern immediately after surgery, which in the treatment group was reversed after 24 h. However, the reconstructed patients had a more intense and prolonged restrictive pattern (P<0.05). Surgical morbidity included one seroma observed in the control group. No infections occurred at the surgical site or at any other level, and no patient developed any metabolic disorder. No mortality was observed in either group. Conclusions: This study establishes that a single preoperative dose of dexamethasone markedly decreased the incidence of postoperative nausea and vomiting and pain, improved respiratory parameters, and decreased the need for additional postoperative analgesic or antiemetic drugs. Clinical Trial Registration: ClinicalTrials.gov (ID NCT02305173). Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-366). The authors have no conflicts of interest to declare. (2020 Gland Surgery. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu