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Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS)
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Journal Article
Dexamethasone reduces emesis after major gastrointestinal surgery (DREAMS)
2013
Overview
Background
Postoperative nausea and vomiting is one of the most common complications affecting patients after surgery and causes significant morbidity and increased length of hospital stay. It is accepted that patients undergoing surgery on the bowel are at a higher risk. In the current era of minimally invasive colorectal surgery combined with enhanced recovery, reducing the incidence and severity of postoperative nausea and vomiting is particularly important. Dexamethasone is widely, but not universally used. It is known to improve appetite and gastric emptying, thus reduce vomiting. However, this benefit is not established in patients undergoing bowel surgery, and dexamethasone has possible side effects such as increased risk of wound infection and anastomotic leak that could adversely affect recovery.
Design
DREAMS is a phase III, double-blind, multicenter, randomized controlled trial with the primary objective of determining if preoperative dexamethasone reduces postoperative nausea and vomiting in patients undergoing elective gastrointestinal resections. DREAMS aims to randomize 1,350 patients over 2.5 years.
Patients undergoing laparoscopic or open colorectal resections for malignant or benign pathology are randomized between 8 mg intravenous dexamethasone and control (no dexamethasone). All patients are given one additional antiemetic at the time of induction, prior to randomization. Both the patient and their surgeon are blinded as to the treatment arm.
Secondary objectives of the DREAMS trial are to determine whether there are other measurable benefits during recovery from surgery with the use of dexamethasone, including quicker return to oral diet and reduced length of stay. Health-related quality of life, fatigue and risks of infections will be investigated.
Trial registration
ISRCTN21973627
Publisher
BioMed Central,BioMed Central Ltd
Subject
Administration, Intravenous - adverse effects
/ Antiemetics - administration & dosage
/ Complications and side effects
/ Dexamethasone - administration & dosage
/ Dexamethasone - adverse effects
/ Digestive System Surgical Procedures - adverse effects
/ England
/ Humans
/ Medicine
/ Nausea
/ Postoperative Nausea and Vomiting - etiology
/ Postoperative Nausea and Vomiting - prevention & control
/ Statistics for Life Sciences
/ Surgery
/ Vomiting
