Improved recovery from vaginal surgery with dexamethasone

1. Use of dexamethasone prior to vaginal prolapse surgery for pelvic organ prolapse was associated with less postoperative nausea and vomiting.

2. Patients who received dexamethasone were more likely to pass postoperative voiding trials compared to those on placebo.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Vaginal reconstruction for pelvic organ prolapse (POP) is a common, minimally invasive surgery that can vastly improve a woman’s quality of life. Further, it often requires only a one-day hospital stay and is associated with less morbidity than abdominal surgery. However, postoperative complications, like pain, nausea, and vomiting can complicate recovery and delay discharge. Dexamethasone is a widely used steroid that is inexpensive and has an excellent safety profile. Multiple studies demonstrated that dexamethasone is effective at improving postoperative nausea and pain in a range of surgeries, from cesarean sections, to laparoscopic gallbladder removal. It has never, however, been studied specifically in vaginal surgery for POP and can be associated with complications such as short-term immunosuppression and insulin resistance. In the present work, researchers assessed whether dexamethasone administration prior to general anesthesia was associated with improved recovery among women undergoing vaginal prolapse surgery.

Patients who received dexamethasone experienced an improved recovery as measured by post-operative nausea, emesis, and ability to void. Strengths of this double-blinded, randomized placebo-controlled trial included rigorous study design. Limitations included small sample size and exclusion of women with medical comorbidities (e.g. poorly controlled diabetes) which limits external validity, particularly since a plurality of women undergoing vaginal prolapse surgery are poor candidates for invasive surgery due to their comorbid conditions. Future studies might employ a larger patient population that includes women with medical morbidities to help answer this question.

Click to read the study in AJOG

Relevant Reading: Effect of dexamethasone on prevention of postoperative nausea, vomiting and pain after caesarean section

In-Depth [randomized controlled trial]: Women undergoing vaginal reconstructive surgery for POP were randomized to receive 8mg IV dexamethasone (n = 27) or placebo (n = 36) 60 minutes prior to surgery. The primary outcome was difference in Quality of Recovery (QoR-40) score 1 day postoperatively, where a lower difference indicates less symptomatology. Secondary outcomes included nausea and vomiting (PONV score) and Visual Analog Scales (VAS) for nausea/vomiting and pain.

Postoperatively, patients who received placebo were more likely to require antiemetics (11 vs 2, p = 0.029) and fail voiding trials (30 vs. 15; p = 0.037) compared to those randomized to dexamethasone. Those who received dexamethasone had a smaller decline in the QoR-40 “emotional state” domain (p = 0.04) and a lower VAS score for nausea/vomiting (p = 0.04). No adverse effects were noted among women randomized to dexamethasone.

Image: PD

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