DREAMS
Trial question
What is the effect of dexamethasone on the risk of postoperative nausea and vomiting in patients undergoing large and small bowel surgery?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 1350
1350 patients (567 female, 783 male)
Inclusion criteria: patients aged ≥ 18 years undergoing elective open or laparoscopic bowel surgery for malignant or benign pathology
Key exclusion criteria: pregnancy; gastrointestinal obstruction; diabetes; glaucoma; active gastric ulceration confirmed by endoscopy; known hypersensitivity to dexamethasone; receipt of systemic corticosteroids
Interventions
N=674 dexamethasone (a single IV dose of 8 mg at induction of anesthesia)
N=676 standard care (a routine preoperative antiemetic other than dexamethasone)
Primary outcome
Postoperative vomiting within 24 hours of surgery
25.5
33.2
33.2 %
24.9 %
16.6 %
8.3 %
0.0 %
Dexamethasone
Standard
care
Significant
decrease ▼
NNT = 12
Significant decrease in postoperative vomiting within 24 hours of surgery (25.5% vs. 33.2%; RR 0.77, 95% CI 0.65 to 0.92)
Secondary outcomes
Significant decrease in postoperative antiemetics in the first 24 hours after surgery (39.3% vs. 51.9%; RR 0.76, 95% CI 0.67 to 0.85)
Significant decrease in clinically important postoperative nausea and vomiting at 24 hours after surgery (8.6% vs. 12.7%; RR 0.68, 95% CI 0.49 to 0.94)
No significant difference in fatigue, measured by functional assessment of Chronic Illness-Fatigue Questionnaire (129.2 vs. 127.5 ; AD 1.7 , 95% CI -0.9 to 4.3)
Safety outcomes
No significant differences in death, infection, anastomotic leak, and intra-abdominal abscesses.
Significant difference in return to oral diet and fluids at 24 hours (62.3% vs. 53.1%).
Conclusion
In patients aged ≥ 18 years undergoing elective open or laparoscopic bowel surgery for malignant or benign pathology, dexamethasone was superior to standard care with respect to postoperative vomiting within 24 hours of surgery.
Reference
DREAMS Trial Collaborators and West Midlands Research Collaborative. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS Trial). BMJ. 2017 Apr 18;357:j1455.
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