Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery

Background Glucocorticoids are commonly administered before ambulatory surgery, although their effects on quality of recovery are not well characterized. The purpose of this study was to evaluate the dose-dependent effects of dexamethasone on patient recovery using the Quality of Recovery 40 questionnaire (QoR-40) after ambulatory surgery. Methods This prospective, double-blind trial studied 106 female subjects undergoing outpatient gynaecological laparoscopy. Subjects were randomized to receive saline, dexamethasone 0.05 mg kg^-1 or dexamethasone 0.1 mg kg^-1 before induction. The primary outcome was global QoR-40 at 24 h. Postoperative pain, analgesic consumption, side-effects, and discharge time were also evaluated. Results Global median (IQR) QoR-40 after dexamethasone 0.1 mg kg ^-1 193 (192-195) was greater than dexamethasone 0.05 mg kg ^-1 179 (175-185) (P=0.004) or saline, 171 (160182) (P<0.005). Median (IQR) morphine equivalents administered before discharge were 2.7 (06.3) mg after dexamethasone 0.1 mg kg^-1 compared with 5.3 (2.4-8.8) mg and 5.3 (2.7-7.8) mg after dexamethasone 0.05 mg kg^-1 and saline (P=0.02). Time to meet discharge criteria was 30 min shorter after dexamethasone 0.1 mg kg^-1 compared with saline (P=0.005). At 24 h, subjects receiving dexamethasone 0.1 mg kg^-1 had consumed less opioid analgesics, reported less sore throat, muscle pain, confusion, difficulty in falling asleep, and nausea compared with dexamethasone 0.05 mg kg^-1 and saline. Conclusions Dexamethasone demonstrated dose-dependent effects on quality of recovery. Dexamethasone 0.1 mg kg^-1 reduced opioid consumption compared with dexamethasone 0.05 mg kg^-1, which may be beneficial for improving recovery after ambulatory gynaecological surgery.