Clinical trial NCT02304250: Dexamethasone and Wound Healing After Thyroid Surgery
Official title: The Effect of Dexamethasone on Safety of Thyroid Surgery
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Wound Infection
Lead sponsor: Shanghai 6th People's Hospital
Sponsor class: OTHER
First posted: 2014-12-01
Enrollment: 220
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Dexamethasone is a potent glucocorticoid with analgesic and anti-emetic effects \[1-3\]. Perioperative single-dose dexamethasone therapy has been used for several purposes: to reduce post-operative nausea and vomiting (PONV), pain and sore throat. There are also some reports on beneficial effects of less cardiac arrhythmia, improved appetite and less edema from glucocorticoids. Preoperative small dose of dexamethasone was reported to prevent reversal laryngeal nerve injury and improve voice quality after thyroid surgery. While accepted wildly in clinical anesthesia practice, the immune-press related potential risks of side effects associated with dexamethasone, such as delayed wound healing, infection, as well as effects on blood sugar, make the use of perioperative single dose of glucocorticoid controversial. The effect of perioperative dexamethasone on wound healing varied with different types of surgery. The present study will observe the effect of dexamethasone on the safety of thyroid surgery.

Detailed description: Patients who has the thyroid surgery for their thyroid cancer will be randomly allocated into two groups, either dexamethasone group or saline group. In the dexamethasone group, patients will receive 5mg dexamethasone iv right after general anesthesia induction while in the saline group, patients will have 1ml saline iv. The drainage fluid will be collected at 6 hours after surgery and on every morning after operation till the drainage tube is taken out. The total amount of drainage fluid and blood stain area in dressing will be collected and calculated after the operation. The C-reaction protein is checked in drainage fluid and in blood after operation. Besides, the pain scores of incision pain and throat pain will be evaluated. Postoperative nausea and vomit will be checked as well.

Eligibility criteria: Inclusion Criteria:

* Elective total thyroidectomy or hemithyroidectomy with lymphadenectomy for thyroid cancer

Exclusion Criteria:

* Age \> 65 years, \< 18 years
* Thyroid tumor with Grave's disease
* Thyroid tumor size over 5 cm
* Second or more than 2 times for thyroid surgery
* Non-traditional pathway for thyroid surgery
* ASA \> II
* Pharyngitis
* Smoking, alcohol drinking history
* Contraindication or long term use of dexamethasone (allege, ulcer bleeding history, et al)

Primary outcomes:
measure: the total wound drain after the operation, including the drain in bulb and stain area in dressings,
timeFrame: from postoperative day 0 to postoperative day 4
Secondary outcomes:
measure: patient pain scores, including incision pain and throat pain,
timeFrame: from postoperative day 0 to one month after operation
measure: c-reaction protein levels in drainage fluid and blood during perioperative period.
timeFrame: from postoperative day 0 to postoperative day 4
Other outcomes:
measure: patient nausea/vomiting scores
timeFrame: from postoperative day 0 to 3 days after operation
measure: other side effects from the surgery
timeFrame: from postoperative day 0 to one month after the operation
Locations:
city: Shanghai
country: China
facility: Shanghai 6Th People'S Hospital
state: Shanghai
Study officials:
affiliation: Shanghai Jiao Tong University School of Medicine
name: WEIPING JIA, Ph.D
role: STUDY_CHAIR
References:
citation: Zhang H, Lu J, Wu Q, Wu B, Xu C, Fan Y, Zhou Q. A Perioperative Small Dose of Dexamethasone Enhances Postoperative Recovery by Reducing Volume and Inflammatory Contents in Wound Drainage After Thyroid Surgery: A Double-Blinded, Randomized, Prospective Study. World J Surg. 2019 Jul;43(7):1721-1727. doi: 10.1007/s00268-019-04986-0.