Dexamethasone and Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial
-
Fezzeh Elyasinia
,
Ahmadreza Soroush
,
Khosrow Najjari
,
Mohammad Talebpour
,
Amir Mohammad Barani
,
Reza Eslamian
,
Hossein Zabihi-Mahmoudabadi
,
Morteza Ahmadinasab
Abstract
Background: Laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder in patients experiencing gallstones or acute cholecystitis. Pain is a common side effect of surgery. Objective: This study evaluates the effectiveness of intraperitoneal dexamethasone injection from the umbilical port site in alleviating pain after laparoscopic cholecystectomy.
Methods: This research followed a triple-blind clinical trial that included 80 randomly selected patients who were hospitalized at Shahid Mohammadi Hospital in Bandar Abbas and deemed eligible for laparoscopic cholecystectomy. Patients were randomly divided into two groups, each containing 40 participants. In the test group, 8 mg of dexamethasone was injected into the intraperitoneal space through the umbilical port site during surgery, while no drug was administered in the control group. Pain scores were measured postoperatively using the VAS questionnaire at 6, 12, and 18 hours after surgery. The collected data were analyzed using SPSS version 21 statistical software, employing independent t-tests and chi-square tests. Results: The experimental group exhibited significantly lower levels of nausea, vomiting, analgesic consumption, and pain compared to the control group (p<0.000).
Conclusions: Study confirmed that intraperitoneal dexamethasone infusion from the port site significantly reduced postoperative pain, nausea, vomiting, and the consumption of painkillers.
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Eur J Surg. 2001;167(2):84-96. https://doi.org/10.1080/110241501750070510
3. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215-25. https://doi.org/10.1016/S0140-6736(11)60245-6
4. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98. https://doi.org/10.2147/JPR.S144066
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meta-analysis. Int J Surg. 2017;44:122-7. https://doi.org/10.1016/j.ijsu.2017.06.047
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7. Saadati K, et al. Postoperative pain relief after laparoscopic cholecystectomy: intraperitoneal sodium bicarbonateversus normal saline. Gastroenterol Hepatol Bed Bench. 2016;9(3):189-96.
8. Singla S, et al. Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumoperitoneum. J Clin Diagn Res. 2014;8(2):92-4.
9. Neupert EA 3rd, et al. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg. 1992;50(11):1177-82; discussion 1182-3. https://doi.org/10.1016/0278-2391(92)90149-T
10. Karst M, et al. Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery. 2003;53(2):331-6; discussion 336-7. https://doi.org/10.1227/01.NEU.0000073530.81765.6B
11. Johnson DB, Lopez MJ, Kelley B. Dexamethasone. StatPearls. 2024.
12. Wang JJ, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. 1999;83(5):772-5. https://doi.org/10.1093/bja/83.5.772
13. Carr MM, et al. Effect of steroids on post tonsillectomy pain in adults. Arch Otolaryngol Head Neck Surg. 1999;125(12):1361-4. https://doi.org/10.1001/archotol.125.12.1361
14. Al-Shehri AM. Steroid therapy for post-tonsillectomy symptoms in adults: a randomized, placebo-controlled study. Ann Saudi Med. 2004;24(5):365-7. https://doi.org/10.5144/0256-4947.2004.365
15. Yamanaga S, et al. A single perioperative injection of dexamethasone decreases nausea,
vomiting, and pain after laparoscopic donor nephrectomy. J Transplant. 2017;2017:3518103.
https://doi.org/10.1155/2017/3518103
16. Asgari Z, et al. Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy. Int J Fertil Steril. 2012;6(1):59-64.
17. Mohtadi A, et al. The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy. Anesth Pain Med. 2014;4(3):e17872. https://doi.org/10.5812/aapm.17872
18. Elhakim M, et al. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49(9):922-6. https://doi.org/10.1007/BF03016875
19. Azimi H, Khademabbasi S. The results of laparoscopic cholecystectomy in Arta and Sabalan hospitals of Ardabil (2006-2009). J Ardabil Univ Med Sci. 2011;11(3):238-45.
20. Ure B, et al. Pain after laparoscopic cholecystectomy: intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events.
Surg Endosc. 1994;8:90-6. https://doi.org/10.1007/BF00316616
21. Moore SG. Intravenous dexamethasone as an analgesic: a literature review. AANA J. 2018;86(6):488-93.
22. Jamil K, Qaisar R. The effect of dexamethasone on postoperative pain in patients after laparoscopic cholecystectomy. Cureus. 2022;14(11):e32067. https://doi.org/10.7759/cureus.32067
23. Bisgaard T, et al. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238(5):651-60. https://doi.org/10.1097/01.sla.0000094390.82352.cb
24. Meng J, Li L. The efficiency and safety of dexamethasone for pain control in total joint arthroplasty: a metaanalysis of randomized controlled trials. Medicine (Baltimore). 2017;96(24):e7126. https://doi.org/10.1097/MD.0000000000007126
25. De Oliveira GS Jr, et al. Perioperative single dose systemic dexamethasone for postoperative pain: a metaanalysisof randomized controlled trials. Anesthesiology. 2011;115(3):575-88. https://doi.org/10.1097/ALN.0b013e31822a24c2
26. Bansal T, et al. Dexamethasone in anesthesia practice: a narrative review. J Anaesthesiol Clin Pharmacol. 2024;40(1):3-8. https://doi.org/10.4103/joacp.joacp_164_22
27. Corcoran TB, et al. Dexamethasone and surgical-site infection. N Engl J Med. 2021;384(18):1731-41. https://doi.org/10.1056/NEJMoa2028982
28. Auphan N, et al. Immunosuppression by glucocorticoids: inhibition of NF-κB activity through induction of IκB synthesis. Science. 1995;270(5234):286-90. https://doi.org/10.1126/science.270.5234.286
2. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy.
Eur J Surg. 2001;167(2):84-96. https://doi.org/10.1080/110241501750070510
3. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215-25. https://doi.org/10.1016/S0140-6736(11)60245-6
4. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98. https://doi.org/10.2147/JPR.S144066
5. Zhang Y, Wang Y, Zhang X. Effect of pre-emptive pregabalin on pain management in patients undergoing laparoscopic cholecystectomy: A systematic review and
meta-analysis. Int J Surg. 2017;44:122-7. https://doi.org/10.1016/j.ijsu.2017.06.047
6. Haneef AK, et al. Active gas aspiration in reducing pain after laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2024;38(2):597-606. https://doi.org/10.1007/s00464-023-10651-4
7. Saadati K, et al. Postoperative pain relief after laparoscopic cholecystectomy: intraperitoneal sodium bicarbonateversus normal saline. Gastroenterol Hepatol Bed Bench. 2016;9(3):189-96.
8. Singla S, et al. Pain management after laparoscopic cholecystectomy-a randomized prospective trial of low pressure and standard pressure pneumoperitoneum. J Clin Diagn Res. 2014;8(2):92-4.
9. Neupert EA 3rd, et al. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg. 1992;50(11):1177-82; discussion 1182-3. https://doi.org/10.1016/0278-2391(92)90149-T
10. Karst M, et al. Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Neurosurgery. 2003;53(2):331-6; discussion 336-7. https://doi.org/10.1227/01.NEU.0000073530.81765.6B
11. Johnson DB, Lopez MJ, Kelley B. Dexamethasone. StatPearls. 2024.
12. Wang JJ, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth. 1999;83(5):772-5. https://doi.org/10.1093/bja/83.5.772
13. Carr MM, et al. Effect of steroids on post tonsillectomy pain in adults. Arch Otolaryngol Head Neck Surg. 1999;125(12):1361-4. https://doi.org/10.1001/archotol.125.12.1361
14. Al-Shehri AM. Steroid therapy for post-tonsillectomy symptoms in adults: a randomized, placebo-controlled study. Ann Saudi Med. 2004;24(5):365-7. https://doi.org/10.5144/0256-4947.2004.365
15. Yamanaga S, et al. A single perioperative injection of dexamethasone decreases nausea,
vomiting, and pain after laparoscopic donor nephrectomy. J Transplant. 2017;2017:3518103.
https://doi.org/10.1155/2017/3518103
16. Asgari Z, et al. Intraperitoneal dexamethasone as a new method for relieving postoperative shoulder pain after gynecologic laparoscopy. Int J Fertil Steril. 2012;6(1):59-64.
17. Mohtadi A, et al. The effect of single-dose administration of dexamethasone on postoperative pain in patients undergoing laparoscopic cholecystectomy. Anesth Pain Med. 2014;4(3):e17872. https://doi.org/10.5812/aapm.17872
18. Elhakim M, et al. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth. 2002;49(9):922-6. https://doi.org/10.1007/BF03016875
19. Azimi H, Khademabbasi S. The results of laparoscopic cholecystectomy in Arta and Sabalan hospitals of Ardabil (2006-2009). J Ardabil Univ Med Sci. 2011;11(3):238-45.
20. Ure B, et al. Pain after laparoscopic cholecystectomy: intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events.
Surg Endosc. 1994;8:90-6. https://doi.org/10.1007/BF00316616
21. Moore SG. Intravenous dexamethasone as an analgesic: a literature review. AANA J. 2018;86(6):488-93.
22. Jamil K, Qaisar R. The effect of dexamethasone on postoperative pain in patients after laparoscopic cholecystectomy. Cureus. 2022;14(11):e32067. https://doi.org/10.7759/cureus.32067
23. Bisgaard T, et al. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238(5):651-60. https://doi.org/10.1097/01.sla.0000094390.82352.cb
24. Meng J, Li L. The efficiency and safety of dexamethasone for pain control in total joint arthroplasty: a metaanalysis of randomized controlled trials. Medicine (Baltimore). 2017;96(24):e7126. https://doi.org/10.1097/MD.0000000000007126
25. De Oliveira GS Jr, et al. Perioperative single dose systemic dexamethasone for postoperative pain: a metaanalysisof randomized controlled trials. Anesthesiology. 2011;115(3):575-88. https://doi.org/10.1097/ALN.0b013e31822a24c2
26. Bansal T, et al. Dexamethasone in anesthesia practice: a narrative review. J Anaesthesiol Clin Pharmacol. 2024;40(1):3-8. https://doi.org/10.4103/joacp.joacp_164_22
27. Corcoran TB, et al. Dexamethasone and surgical-site infection. N Engl J Med. 2021;384(18):1731-41. https://doi.org/10.1056/NEJMoa2028982
28. Auphan N, et al. Immunosuppression by glucocorticoids: inhibition of NF-κB activity through induction of IκB synthesis. Science. 1995;270(5234):286-90. https://doi.org/10.1126/science.270.5234.286
| Files | ||
| Issue | Vol 8 No 1 (2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Cholecystectomy Laparoscopy Dexamethasone Intraperitoneal injection Pain | ||
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How to Cite
1.
Elyasinia F, Soroush A, Najjari K, Talebpour M, Barani AM, Eslamian R, Zabihi-Mahmoudabadi H, Ahmadinasab M. Dexamethasone and Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial. AJS. 2025;8(1):22-28.
