TY - JOUR
T1 - Dexamethasone and clinically significant postoperative nausea and vomiting
T2 - a prespecified substudy of the randomised perioperative administration of dexamethasone and infection (PADDI) trial
AU - Corcoran, Tomás B.
AU - Martin, Catherine
AU - O'Loughlin, Edmond
AU - Ho, Kwok M.
AU - Coutts, Pauline
AU - Chan, Matthew T.
AU - Forbes, Andrew
AU - Leslie, Kate
AU - Myles, Paul
N1 - Funding Information:
The Australian National Health and Medical Research Council ( APP1079501 ), Monash University , and the Research Grant Council of Hong Kong (General Research Fund 14101816). Professor Tomás Corcoran was supported by a Health Department of Western Australia Raine Foundation Clinical Practitioner Fellowship. The trial funders had no involvement in the design of the study; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Publisher Copyright:
© 2022 British Journal of Anaesthesia
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Background: Clinically significant postoperative nausea and vomiting (PONV) is a patient-reported outcome which reflects patient experience. Although dexamethasone prevents PONV, it is unknown what impact it has on this experience. Methods: In this prespecified embedded superiority substudy of the randomised Perioperative Administration of Dexamethasone and Infection (PADDI) trial, patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or placebo intravenously after induction of anaesthesia, and completed a validated PONV questionnaire. The primary outcome was the incidence of clinically significant PONV on day 1 or day 2 postoperatively. Secondary outcomes included the incidence of clinically significant PONV and severe PONV on days 1 and 2 considered separately. Results: A total of 1466 participants were included, with 733 patients allocated to the dexamethasone arm and 733 to matched placebo. The primary outcome occurred in 52 patients (7.1%) in the dexamethasone arm and 66 (9%) patients in the placebo arm (relative risk [RR]=0.79; 95% confidence interval [CI], 0.56–1.11; P=0.18). Severe PONV occurred on day 2 in 27 patients (3.9%) in the dexamethasone arm and 47 patients (6.7%) in the placebo arm (RR=0.58; 95% CI, 0.37–0.92; P=0.02; number needed-to-treat (NNT)=36.7; 95% CI, 20–202). In the entire cohort of 8880 PADDI patients, lower nausea scores, less frequent administration of antiemetics, and fewer vomiting events were recorded by patients in the dexamethasone arm up to day 2 after surgery. Conclusions: Administration of dexamethasone 8 mg i.v. did not influence clinically significant PONV. Dexamethasone administration did, however, decrease the incidence and severity of PONV, and was associated with less frequent administration of antiemetic agents. Clinical trial registration: ACTRN12614001226695.
AB - Background: Clinically significant postoperative nausea and vomiting (PONV) is a patient-reported outcome which reflects patient experience. Although dexamethasone prevents PONV, it is unknown what impact it has on this experience. Methods: In this prespecified embedded superiority substudy of the randomised Perioperative Administration of Dexamethasone and Infection (PADDI) trial, patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or placebo intravenously after induction of anaesthesia, and completed a validated PONV questionnaire. The primary outcome was the incidence of clinically significant PONV on day 1 or day 2 postoperatively. Secondary outcomes included the incidence of clinically significant PONV and severe PONV on days 1 and 2 considered separately. Results: A total of 1466 participants were included, with 733 patients allocated to the dexamethasone arm and 733 to matched placebo. The primary outcome occurred in 52 patients (7.1%) in the dexamethasone arm and 66 (9%) patients in the placebo arm (relative risk [RR]=0.79; 95% confidence interval [CI], 0.56–1.11; P=0.18). Severe PONV occurred on day 2 in 27 patients (3.9%) in the dexamethasone arm and 47 patients (6.7%) in the placebo arm (RR=0.58; 95% CI, 0.37–0.92; P=0.02; number needed-to-treat (NNT)=36.7; 95% CI, 20–202). In the entire cohort of 8880 PADDI patients, lower nausea scores, less frequent administration of antiemetics, and fewer vomiting events were recorded by patients in the dexamethasone arm up to day 2 after surgery. Conclusions: Administration of dexamethasone 8 mg i.v. did not influence clinically significant PONV. Dexamethasone administration did, however, decrease the incidence and severity of PONV, and was associated with less frequent administration of antiemetic agents. Clinical trial registration: ACTRN12614001226695.
KW - antiemetic
KW - complication
KW - dexamethasone
KW - glucocorticoid
KW - patient-centred outcome
KW - postoperative nausea and vomiting
UR - http://www.scopus.com/inward/record.url?scp=85133678625&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2022.05.018
DO - 10.1016/j.bja.2022.05.018
M3 - Article
C2 - 35803757
AN - SCOPUS:85133678625
SN - 0007-0912
VL - 129
SP - 327
EP - 335
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -