Department of Surgery, University of L’Aquila, Abruzzo, Italy.
JAMA Otolaryngol Head Neck Surg. 2013 May;139(5):471-8. doi: 10.1001/jamaoto.2013.2821.
Recurrent laryngeal nerve dysfunction and hypoparathyroidism are well-recognized, important complications of thyroid surgery. The duration of convalescence after noncomplicated thyroid operation may depend on several factors, of which pain and fatigue are the most important. Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune-modulating and antiemetic effects. However, there is little information in the literature on the use of steroids in thyroid surgery, and the information that is available is conflicting.
To investigate whether preoperative dexamethasone could improve surgical outcome in patients undergoing thyroid surgery.
A randomized double-blind placebo-controlled trial. A 30-day follow-up for morbidity was performed in all cases.
All patients were hospitalized in a public hospital.
From June 2008 through August 2011, 328 patients were randomized to receive either intravenous dexamethasone, 8 mg, administered 90 minutes before skin incision, or saline solution (placebo).
Intravenous dexamethasone, 8 mg.
The primary end points were temporary or permanent recurrent laryngeal nerve palsy. Transient and definitive hypoparathyroidism, pain and fatigue scores, nausea, and the number of vomiting episodes were also registered. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein, interleukin 6, and interleukin 1β levels.
In the dexamethasone group, the rate of temporary recurrent laryngeal nerve palsy (4.9%) was significantly lower compared with the placebo group (8.4%) (P = .04). Also, postoperative transient biochemical hypoparathyroidism occurred more frequently in the placebo group (37.0%) than in the dexamethasone group (12.8%). Dexamethasone use significantly reduced postoperative levels of C-reactive protein (P = .01) and interleukin 6 and interleukin 1β (P = .02), fatigue (P = .01), and overall pain during the first 24 postoperative hours (P = .04), as well as the total analgesic (ketorolac tromethamine) requirement (P = .04). Dexamethasone use also reduced nausea and vomiting on the day of operation (P = .045).
Preoperative administration of dexamethasone, 8 mg, reduced postoperative temporary recurrent laryngeal nerve palsy and hypoparathyroidism rates and reduced pain, fatigue, nausea, and vomiting after thyroid surgery. However, these data require further analysis in randomized prospective studies. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01690806.
喉返神经功能障碍和甲状旁腺功能减退是甲状腺手术后公认的重要并发症。非复杂甲状腺手术后的恢复期可能取决于几个因素，其中疼痛和疲劳是最重要的。恶心和呕吐主要发生在手术当天。糖皮质激素具有镇痛、抗炎、免疫调节和止吐作用，已得到广泛认可。然而，文献中关于甲状腺手术中使用类固醇的信息很少，而且可用的信息相互矛盾。
研究术前地塞米松是否可以改善甲状腺手术患者的手术结果。
一项随机双盲安慰剂对照试验。所有病例均进行 30 天的发病率随访。
所有患者均在一家公立医院住院。
2008 年 6 月至 2011 年 8 月，328 名患者被随机分为接受静脉注射地塞米松 8mg 组，在皮肤切开前 90 分钟给药，或生理盐水（安慰剂）组。
静脉注射地塞米松 8mg。
主要终点是暂时性或永久性喉返神经麻痹。还记录了暂时性和永久性甲状旁腺功能减退、疼痛和疲劳评分、恶心和呕吐发作次数。术前和术后 24 小时内的几个时间点，我们测量了 C 反应蛋白、白细胞介素 6 和白细胞介素 1β 水平。
地塞米松组暂时性喉返神经麻痹（4.9%）的发生率明显低于安慰剂组（8.4%）（P =.04）。此外，术后暂时性生化性甲状旁腺功能减退在安慰剂组（37.0%）比地塞米松组（12.8%）更为常见。地塞米松的使用显著降低了术后 C 反应蛋白（P =.01）、白细胞介素 6 和白细胞介素 1β（P =.02）、疲劳（P =.01）以及术后 24 小时内的总体疼痛（P =.04），以及总镇痛（酮咯酸氨丁三醇）需求（P =.04）。地塞米松的使用还减少了手术当天的恶心和呕吐（P =.045）。
术前给予 8mg 地塞米松可降低甲状腺手术后暂时性喉返神经麻痹和甲状旁腺功能减退的发生率，并减轻甲状腺手术后的疼痛、疲劳、恶心和呕吐。然而，这些数据需要在随机前瞻性研究中进一步分析。试验注册：clinicaltrials.gov 标识符：NCT01690806。
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