The effect of dexamethasone on functional pain following Transoral Robotic Surgery: a randomized double blinded clinical trial

Abstract

Background

Pain is prevalent after most TransOral Robotic Surgery (TORS) procedures and may limit function i.e. swallowing. Currently, there is limited knowledge regarding optimal pain treatment in TORS.

Aims/objectives

This clinical trial randomized patients to either a high-dose dexamethasone or low-dose dexamethasone treatment in addition to a multimodal basic analgesic protocol. The aim of the trial was to investigate the pain intensity during rest and swallowing using the Visual Analogue Scale (VAS) after TORS lingual tonsillectomy. Secondary outcomes were acceptable food consistency, nausea, vomiting, opioid rescue usage, length of hospitalization, feeding tube placements, readmissions, blood glucose levels and postoperative complications.

Methods

The trial was conducted between August 2020 and October 2022. Eligible patients were patients scheduled for TORS-L treatment of obstructive sleep apnea syndrome or as part of the diagnostic work-up of head and neck carcinoma of unknown primary.

Results

Eighteen patients were and randomized 1:1. There were overall no significant differences between groups in the reported VAS scores during rest or swallowing (p ≥ .05). Overall, there were no differences in the secondary outcomes.

Conclusion

There were no differences in the pain intensity in the two treatment groups allocated to a basic multimodal analgesic package and either high-dose dexamethasone or low-dose dexamethasone treatment. The trial is the first RCT to include pain measurement during a procedure-relevant activity, thus creating a platform for future recovery studies.

Chinese Abstract

背景: 大多数经口机器人手术 (TORS) 术后普遍存在疼痛, 并且可能会限制功能, 即吞咽。 目前, 关于 TORS 最佳疼痛治疗的知识是有限的。

目的: 该临床试验将患者随机成两类, 除多模式基本镇痛方案外, 采用高剂量地塞米松或采用低剂量地塞米松治疗。 该试验的目的是使用视觉模拟量表 (VAS)来探讨TORS 舌扁桃体切除术后, 静态和吞咽期间的疼痛强度。 次要结果是可接受食物的一致性、恶心、呕吐、阿片类药物抢救使用、住院时间、饲管放置、再入院、血糖水平和术后并发症。

方法: 该试验于 2020 年 8 月至 2022 年 10 月期间进行。符合条件的是那些计划接受 TORS-L 治疗阻塞性睡眠呼吸暂停综合征的患者, 或接受原发灶不明头颈癌的诊断检查的部分患者。

结果: 18 名患者按 1:1 进行随机分组。在静态或吞咽期间报告的 VAS 评分在两组之间存在总体上没有显著差异 (p≥.05)。 总体而言, 次要结果无差异。

结论: 分配至不同治疗组的两个治疗组的疼痛强度没有差异。他们被给予基本的多模式镇痛药包加上高剂量地塞米松或低剂量地塞米松治疗。 该试验是纳入手术相关活动期间疼痛测量的首次随机对照试验, 从而为未来的恢复研究创建一个平台。

Keywords:

• Transoral robotic surgery
• pain
• recovery

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This study was supported by a private non-profit foundation, Candys Foundation [Grant ID: 2019-304], Læge Fritz Karner og hustrus fond (no grant ID), Forskningspuljen mellem OUH og RH [Grant ID: A4723] and Region Hovedstadens Forskningsfond til Sundhedsforskning [Grant ID: A6682].