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The efficacy of single-dose postoperative intravenous dexamethasone for pain relief after endoscopic submucosal dissection for gastric neoplasm

Authors
 Hye Won Lee  ;  Hyuk Lee  ;  Hyunsoo Chung  ;  Jun Chul Park  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Young Chan Lee  ;  Jung Hwa Hong  ;  Dong Wook Kim 
Citation
 Surgical Endoscopy , Vol.28(8) : 2334-2341, 2014 
Journal Title
 Surgical Endoscopy  
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adenoma/pathology ; Adenoma/surgery ; Dexamethasone/administration & dosage* ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Gastric Mucosa/surgery* ; Gastroscopy* ; Glucocorticoids/administration & dosage* ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Multivariate Analysis ; Pain Measurement ; Pain, Postoperative/prevention & control* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery*
Keywords
Endoscopic submucosal dissection ; Early gastric cancer ; Pain relief ; Intravenous dexamethasone ; Present pain intensity
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) is the gold standard technique for en bloc resection of large superficial tumors in the upper and lower gastrointestinal tract. Little is known about the management of epigastric pain after ESD of gastric neoplasms. This study investigated the utility and safety of single-dose, perioperative, intravenous dexamethasone for epigastric pain relief following ESD. METHODS: The efficacy of intravenous dexamethasone 0.15 mg/kg (DEXA group) compared with saline-only placebo (placebo) for epigastric pain after ESD of early gastric neoplasms was assessed in a double-blinded, placebo-controlled trial. Patients completed a questionnaire about present pain intensity (PPI) and short-form McGill pain (SF-MP) categories for immediate and 6-, 12-, and 24-h postoperative periods. The primary outcome variable was PPI at 6 h following ESD. Secondary outcome variables included pain medication, SF-MP scores, complications, second-look endoscopic findings, and length of stay. RESULTS: A total of 36 patients participated in the study. The mean 6-h PPI value was lower (p < 0.001) in the DEXA group (1.61 ± 0.21) than in the placebo group (2.66 ± 0.19). The total 6-h SF-MP score, especially the sensory domain, was higher (p = 0.054) in the placebo group (11.56 ± 0.75) than in the DEXA group (8.89 ± 0.75). Tramadol for epigastric pain relief was more frequent (p = 0.026) in the placebo group (44.4%) than in the DEXA group (11.1%). No differences were noted between groups in length of stay or complications, including acute or delayed bleeding. The distribution of artificial ulcer patterns at 48-h post-ESD as determined by second-look endoscopy was similar in both groups. CONCLUSION: Single-dose perioperative intravenous dexamethasone after ESD effectively relieved epigastric pain 6 h postoperatively.
Full Text
https://link.springer.com/article/10.1007%2Fs00464-014-3463-4
DOI
10.1007/s00464-014-3463-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Hyuk(이혁)
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
Chung, Hyun Soo(정현수)
Hong, Jung Hwa(홍정화)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/163608
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