Dexamethasone appears safe in preventing postsurgery nausea

Although dexamethasone is often used to prevent nausea and vomiting after surgery, concerns have been raised that it may increase the risk of surgical-site infection. A new study from researchers in New Zealand and Australia published on May 6 in the New England Journal of Medicine showed that dexamethasone was noninferior to placebo in the incidence of surgical-site infection within 30 days after nonurgent, noncardiac surgery.  

More than 8,600 adult patients who were undergoing nonurgent, noncardiac surgery of at least 2 hours’ duration, with a skin incision length longer than 5 cm and a postoperative overnight hospital stay, were randomly assigned to receive 8 mg of I.V. dexamethasone or a placebo while under anesthesia. Randomization was stratified according to diabetes status and trial center, and the primary outcome was surgical-site infection within 30 days after surgery.  

Of the 8,678 patients included in the primary analysis, surgical-site infection occurred in 8.1% of patients receiving dexamethasone and in 9.1% receiving a placebo. The results for patients with diabetes were similar to those of the primary analysis. Postoperative nausea and vomiting in the first 24 hours after surgery occurred in 42.2% of patients in the dexamethasone group and in 53.9% in the placebo group, while hyperglycemic events in patients without diabetes occurred in 0.6% in the dexamethasone group and in 0.2% in the placebo group. 

The authors concluded that a single dose of dexamethasone can be used safely to prevent postoperative nausea and vomiting without excess risk for infection.