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Dexamethasone for Morbidity After Subdural Electrode Insertion – A Randomized Controlled Trial

Published online by Cambridge University Press:  02 December 2014

Ramesh L. Sahjpaul ,
Jeff Mahon  and
Samuel Wiebe
Ramesh L. Sahjpaul
Affiliation:
Division of Neurosurgery, University of Western Ontario, London, Ontario, Canada
Jeff Mahon
Affiliation:
Department of Clinical Neurological Sciences, and Department of Medicine, University of Western Ontario, London, Ontario, Canada
Samuel Wiebe
Affiliation:
Division of Neurology, University of Western Ontario, London, Ontario, Canada
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Abstract

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Background:

Invasive monitoring with subdural electrodes (SDE) for investigation of medically intractable epilepsy may be associated with undesirable immediate postoperative morbidity such as headache, nausea, vomiting, fever, and meningism. We undertook to evaluate the potential beneficial role of perioperative dexamethasone in reducing these symptoms.

Methods:

In a double-blind placebo controlled clinical trial 30 patients undergoing SDE insertion were randomized to receive either placebo or a course of dexamethasone beginning one hour prior to surgery and tapering to discontinue over 72 hours postoperatively. Pain, pain relief, nausea, nausea relief, temperature, and meningism were assessed regularly in the postoperative period, and analgesic, antipyretic, and antiemetic drug requirements were tabulated.

Results:

One patient was withdrawn from the dexamethasone group due to lack of data. With regards to postoperative pain, the direction of benefit favoured dexamethasone but a significant treatment by time interaction prevented further analysis of treatment effect. The dexamethasone group did have significantly lower temperatures and higher nausea relief scores. There was no statistically significant difference between the groups with regards to pain relief, nausea, and meningism scores. The beneficial effects of dexamethasone were delayed in onset, of limited duration, and not uniform over the observation period.

Conclusion:

Dexamethasone appears to have a role in reducing immediate morbidity following SDE insertion but its effect is not uniform in the postoperative period; it appears to be delayed in onset, and of limited duration. Further study is necessary to determine the ideal dosing schedule.

Résumé:

RÉSUMÉ:Introduction:

La surveillance effractive au moyen d.électrodes sous-durales (ÉSD) dans l.investigation de l.épilepsie réfractaire au traitement médical peut être associée à une morbidité postopératoire immédiate dont la céphalée, les nausées, les vomissements, l.hyperthermie et le méningisme. Nous avons évalué si la déxaméthasone administrée pendant la période périopératoire pouvait réduire ces symptômes.

Méthodes:

Trente patients qui devaient subir l.insertion d.ÉSD ont été répartis de façon aléatoire au traitement à la déxaméthasone une heure avant la chirurgie et à dose décroissante dans les 72 heures après la chirurgie ou à recevoir un placebo. La douleur, le soulagement de la douleur, les nausées, le soulagement des nausées, la température et le méningisme ont été évalués régulièrement en période postopératoire et les besoins en médicaments analgésiques, antipyrétiques et antiémétiques ont été notés.

Résultats:

Un patient a été exclu du groupe recevant la dexaméthasone à cause de données manquantes. En ce qui concerne la douleur postopératoire, la dexaméthasone semblait être bénéfique, bien que les données n.aient pu être analysées de façon plus poussée à cause d.une interaction entre le traitement et le temps. Le groupe recevant de la dexaméthasone avait une température significativement plus basse ainsi qu.un meilleur score de soulagement des nausées. La différence entre les groupes quant au soulagement de la douleur, aux nausées et au méningisme n.atteignait pas le seuil de la significativité. Les effets bénéfiques de la dexaméthasone avaient un début tardif, une durée limitée et étaient variables pendant la période d.observation.

Conclusion:

La dexaméthasone semble jouer un rôle dans la réduction immédiate de la morbidité après l.insertion d.ÉSD mais son effet est variable pendant la période postopératoire: le début est retardé et l.effet est d.une durée limitée. D.autres etudes sont nécessaires pour déterminer quel est le schéma posologique idéal.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 4 , November 2003 , pp. 340 - 348
Copyright
Copyright © The Canadian Journal of Neurological 2003

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