Effect of 24 mg Dexamethasone Preoperatively on Surgical Stress, Pain and Recovery in Robotic-assisted Laparoscopic Hysterectomy

Background Robotic operations in gynecology is one of the fastest growing fields in applied robotic technology.

In Denmark 4000 hysterectomies are performed each year on benign indications and minimal invasive techniques has risen from 35 to 80%. These operations consist of vaginal, laparoscopic assisted und the latest robotic assisted hysterectomy. Hysterectomy and prostate operations are the most common robotic assisted operations as an alternative to conventional laparoscopy.

Robotic surgery on benign indications in gynecology is still a discussion on the cost vs. benefit due to increased cost and lack of evidence on superiority in surgical outcome compared to conventional laparoscopy. For minimal invasive surgery is but a part of a complex series of treatment in a strategy, the so-called multi-modal regimen (1-7,16). By this, the day of discharge has dramatically decreased without compromising safety during surgery and postoperative recovery. However, not all single elements are proven for efficacy, let alone the specific targets for effect (16).

To further improve the overall outcome of surgery the surgical stress response are investigated, which includes inflammatory components and are of importance of postoperative pain and recovery (8,9,16). Here amongst others, glucocorticoids have proven to relieve pain in a number of procedures, applied in general surgery on colon, gallbladder, and breast, in orthopedic surgery on knee and breast surgery, and in gynecology, too, in laparoscopic hysterectomy (1-10,15,16). The dose of steroid to provide significant analgesic effect is, at least, dexamethasone of 0.1-0.2 mg/kg or 15 mg, which is substantiated in some reduction in inflammatory response (7,15,16). Glucocorticoids are known for analgesic, opioid-sparing and antiemetic effects but procedure-specific outcome are lacking. Similarly, the specific anti-inflammatory and sites of surgical stress-related responses are not well elucidated.

Aim The PhD study evaluate the effects of a single dose of steroid on acute postoperative stress response and pain after hysterectomy. The evaluation is on clinical relevant outcome that directly benefit the patients. We will measure surgical stress by c-reactive protein and other inflammatory markers based on transcriptional profiling, register pain and medication needed during hospital stay and after discharge, and when work and sexual function could be resumed.