Randomized placebo-controlled trial of dexamethasone during induction of anesthesia in lung cancer thoracoscopic resection

Abstract

Objective: Systemic corticosteroids administered during induction of anesthesia are an effective adjunct to control postoperative pain and opioid consumption after several types of surgery. The role of corticosteroids in pain control after thoracic surgery is unknown, however. We conducted a single-institution trial to determine whether administering dexamethasone prior to video-assisted thoracoscopic surgery (VATS) improves postoperative recovery.   Methods: We designed a randomized, placebo-controlled trial according to CONSORT guidelines (Figure 1a). Sample size was calculated to obtain 100 patients with pulmonary lesions, suspected or diagnosed as lung cancer, from 301 patients assessed for eligibility.  The pharmacy computer randomly assigned patients (1:1) to receive either 0.1 mg/kg dexamethasone in a single intravenous dose or placebo during induction of anesthesia. The treatment assigned was masked from the patients and physicians. Resection was primarily performed by uniportal VATS (95%). Postoperative analgesia consisted of acetaminophen, nonsteroidal anti-inflammatory drugs, and patient-controlled analgesia (PCA) with hydromorphone. The primary outcome was postoperative quality of recovery, as assessed by the QoR-40 questionnaire administered daily during hospitalization and 30 days postoperatively. Secondary outcomes included time to first analgesic administration and postoperative opioid consumption. Results: Most patients—39 of 50 (78%) treated with dexamethasone and 35 of 50 (71%) with placebo—underwent VATS lobectomy. All patients (57% female, mean age 64 years) received the allocated intervention; 99 completed follow-up. Median length of stay was 3 days (interquartile range 3, 4) in both groups. There were no significant between-group differences in QoR-40 scores during hospitalization or after 30 days (Figure 1b). Time to first PCA dose was 4.41±1.21 hours in the dexamethasone group and 3.81± 1.20 hours in the placebo group (p=0.07). Total dose of opioids was similar in both groups (p=0.04). Conclusion: Administering dexamethasone during induction anesthesia prior to uniportal VATS for lung cancer does not improve the quality of postoperative recovery.