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Randomized Controlled Trial on Single Dose Steroid Before Thyroidectomy for Benign Disease to Improve Postoperative Nausea, Pain, and Vocal Function

Worni, Mathias MD*; Schudel, Hans H. MS*; Seifert, Eberhard MD†; Inglin, Roman MD*; Hagemann, Matthias MD†; Vorburger, Stephan A. MD, MCR*; Candinas, Daniel MD, FRCS*

Annals of Surgery:
doi: 10.1097/SLA.0b013e31818c709a
Original Articles
Abstract

Objective: To evaluate the effects of a single preoperative dose of steroid on thyroidectomy outcomes.

Background: Nausea, pain, and voice alteration frequently occur after thyroidectomy. Because steroids effectively reduce nausea and inflammation, a preoperative administration of steroids could improve these thyroidectomy outcomes.

Methods: Seventy-two patients (men = 20, women = 52) undergoing thyroidectomy for benign disease were included in this randomized, controlled, 2 armed (group D: 8 mg dexamethasone, n = 37; group C: 0.9% NaCl, n = 35), double-blinded study (clinical trial number NCT00619086). Anesthesia, surgical procedures, antiemetics, and analgesic treatments were standardized. Nausea (0–3), pain (visual analog scale), antiemetic and analgesic requirements, and digital voice recording were documented before and 4, 8, 16, 24, 36, and 48 hours after surgery. Patients were followed-up 30 days after hospital discharge.

Results: Baseline characteristics were similar among the 2 treatment groups. Nausea was pronounced in the first 16 hours postoperatively (scores were <0.3 and 0.8–1.0 for group D and C, respectively (P = 0.005)), and was significantly lower in group D compared with group C during the observation period (P = 0.001). Pain diminished within 48 hours after surgery (visual analog scale 20 and 35 in group D and C, respectively (P = 0.009)). Antiemetic and analgesic requirements were also significantly diminished. Changes in voice mean frequency were less prominent in the dexamethasone group compared with the placebo group (P = 0.015). No steroid-related complications occurred.

Conclusion: A preoperative single dose of steroid significantly reduced nausea, vomiting, and pain, and improved postoperative voice function within the first 48 hours (most pronounced within 16 hours) after thyroid resection; this strategy should be routinely applied in thyroidectomies.

In Brief

In this double-blinded, randomized controlled trial, a single dose of steroid before thyroid surgery significantly improved postoperative nausea, pain, and vocal function compared with placebo treatment. These effects were pronounced in the early postoperative period.

Author Information

From the Department of *Visceral and Transplant Surgery, and †Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.

No reprints will be available from the authors.

Correspondence: Stephan A. Vorburger, MD, MCR, Department of Visceral and Transplant Surgery, University Hospital Bern, CH-3010 Bern, Switzerland. E-mail: stephan.vorburger@insel.ch.

© 2008 Lippincott Williams & Wilkins, Inc.