A randomized controlled trial of corticosteroids for pain after transoral robotic surgery

作者：Clayburgh Daniel^*; Stott Will; Bolognone Rachel; Palmer Andrew; Achim Virginie; Troob Scott; Li Ryan; Brickman Daniel; Graville Donna; Andersen Peter; Gross Neil D

来源：Laryngoscope, 2017, 127(11): 2558-2564.

DOI：10.1002/lary.26625

• corticosteroid
• pain management
• postoperative care
• transoral robotic surgery

ObjectiveTo determine if an extended perioperative course of corticosteroids will improve pain control following transoral robotic surgery (TORS).
Study DesignRandomized, double-blind, placebo-controlled trial.
MethodsPatients undergoing TORS for initial treatment of oropharyngeal squamous cell carcinoma received a single intraoperative dose of 10-mg dexamethasone and then were randomized to receive 8-mg dexamethasone every 8 hours, or placebo, for up to 4 days after surgery. Pain, measured by visual analog scale (VAS), was the primary outcome measure. Secondary outcome measures included length of stay, dysphagia assessments, and complications.
ResultsVAS pain scores were similar between steroid and placebo cohorts on postoperative day (POD) 1, 2, and 7 through 21, although they significantly improved in the steroid cohort on POD 3. The steroid cohort also demonstrated a decreased hospital length of stay (median 1 day) and improvement in diet consistency, as measured by the performance status scale on POD 7 through 21. There was no difference in complications between the steroid and placebo cohorts.
ConclusionExtended perioperative corticosteroids after TORS is safe and may allow earlier improvement in diet consistency and decreased length of hospital stay, although postoperative pain appears minimally affected.
Level of Evidence1b. Laryngoscope, 127:2558-2564, 2017

• 出版日期2017-11