Efficacy of preoperative dexamethasone for postoperative nausea and vomiting after laparoscopic cholecystectomy: a large-scale, multicenter, randomized, double-blind, placebo-controlled trial in Japan

BackgroundTo assess the efficacy of preoperative dexamethasone for postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC) in Japan. MethodsA total of 270 patients at eight hospitals were randomized to receive dexamethasone 8mg (n=136) or placebo (n=134) intravenously before LC. The primary endpoint was the degree of PONV and antiemetic requirements within 24h after LC. Secondary endpoints were postoperative complications, postoperative hospital stay, and cost of hospital stay. This study was registered: UMIN-CTR (UMIN000003841). ResultsWithin 6h after LC, 17% (23/136) of patients in the dexamethasone group versus 24% (32/134) in the placebo group reported nausea (P=0.3), and 5% (7/136) versus 7% (10/134) reported vomiting (P=0.2). Metoclopramide 10mg was used 0.090.31 versus 0.14 +/- 0.35 times (P=0.2). From 6 to 24h, 10% (14/136) versus 13% (17/134) reported nausea (P=0.5), and 5% (7/136) versus 5% (7/134) reported vomiting (P=0.8). Metoclopramide was used 0.04 +/- 0.19 versus 0.03 +/- 0.17 times (P=0.8). Postoperative complications and postoperative hospital stay did not differ significantly between the two groups, but the cost of hospital stay was slightly higher in the dexamethasone group (P<0.05). ConclusionsRoutine use of preoperative dexamethasone for PONV after elective LC in Japan was not shown to have a clinical advantage.