A Comparative Randomized Trial on the Optimal Timing of Dexamethasone for Pain Relief after Endoscopic Submucosal Dissection for Early Gastric Neoplasm

作者：Pyo Jeung Hui; Lee Hyuk^*; Min Yang Won; Min Byung Hoon; Lee Jun Haeng; Rhee Poong Lyul; Kim Jae J

来源：Gut and Liver, 2016, 10(4): 549-555.

DOI：10.5009/gnl15302

• Endoscopic submucosal dissection
• Stomach neoplasms
• Pain
• Dexamethasone

Background/Aims: The aim of this study was to compare the clinical effects of preoperative and postoperative dexamethasone on pain after endoscopic submucosal dissection (ESD) for early gastric neoplasm. Methods: Forty patients with early gastric neoplasm who were scheduled for ESD were randomized into two groups according to the timing of steroid administration: preoperative ("pre", n=20) and postoperative ("post", n=20) steroid administration. The pre group received 0.15 mg/kg dexamethasone before ESD and placebo after, and the post group received pre-ESD placebo and post-ESD dexamethasone. The present pain intensity (PPI) index and the short-form McGill pain (SF-MP) questionnaire were evaluated. Results: The primary outcome was PPI score at 6 hours after ESD. There was a greater reduction in 6-hour PPI in the pre group than in the post group (2.1 +/- 0.8 vs 3.0 +/- 1.1, respectively; p=0.006). The immediate PPI was also significantly lower in the pre group than in the post group (1.6 +/- 0.6 vs 2.9 +/- 0.6, respectively; p<0.001), and the total SF-MP scores were significantly lower in the pre group than in the post group both immediately and at 6 hours after the operation. Conclusions: Preoperative administration of dexamethasone may produce a superior analgesic effect in patients who undergo ESD compared with the postoperative administration of dexamethasone.

• 出版日期2016-7