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

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@article{38f096d8900e4399970b6db310fef46c,
title = "High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial",
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 = "Journal Article",
author = "Bjerregaard, {Lars S} and Jensen, {Per F} and Bigler, {Dennis R} and Petersen, {Ren{\'e} Horsleben} and Hasse M{\o}ller-S{\o}rensen and Kaj Gefke and Hansen, {Henrik J} and Henrik Kehlet",
year = "2018",
doi = "10.1093/ejcts/ezx248",
language = "English",
volume = "53",
pages = "209--215",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "Elsevier BV",
number = "1",

}

RIS

TY - JOUR

T1 - High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy

T2 - a randomized controlled trial

AU - Bjerregaard, Lars S

AU - Jensen, Per F

AU - Bigler, Dennis R

AU - Petersen, René Horsleben

AU - Møller-Sørensen, Hasse

AU - Gefke, Kaj

AU - Hansen, Henrik J

AU - Kehlet, Henrik

PY - 2018

Y1 - 2018

N2 - 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 ].

AB - 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 ].

KW - Journal Article

U2 - 10.1093/ejcts/ezx248

DO - 10.1093/ejcts/ezx248

M3 - Journal article

VL - 53

SP - 209

EP - 215

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

ER -

ID: 51759594