THE EFFECT OF PREOPERATIVE METHYLPREDNISOLONE ON PULMONARY-FUNCTION AND PAIN AFTER LUNG OPERATIONS

Thirty-six patients undergoing elective thoracotomy with pulmonary res ection with the use of combined epidural and general anesthesia were r andomized into a double-blind study to receive a single intravenous pr eoperative dose of methylprednisolone 25 mg/kg body weight or a placeb o (saline solution). Postoperative pain relief consistent of epidural morphine 4 mg and paracetamol 1 gm three times a day for 4 days. Posto perative pulmonary function (peak expiratory flow rate, forced expirat ory volume in first second, forced vital capacity) was evaluated on da ys 1, 2, 3, 4, and 7 and after 1 month. The value obtained after 1 mon th served as the control value. Pain score at rest and during cough wa s evaluated after 4 and 8 hours and on days 1, 2, 3, and 4. Pulmonary function was reduced after operation to the same degree in the steroid and placebo group: 42% versus 41% for forced expiratory volume in fir st second and 38% versus 39% for forced vital capacity, compared with control values after 1 month. Pain score was reduced in the steroid gr oup after 4 hours and on day 1 during rest and after 4 and 8 hours and on day 2 during cough, compared with results in the placebo group (p < 0.05). In the steroid group three patients underwent reoperation bec ause of leakage through the chest wall incision. In conclusion, admini stration of a single preoperative dose of methylprednisolone did not a ffect the postoperative reduction in pulmonary function after thoracot omy despite attenuated pain response, and the results do not warrant s teroid administration before lung operation.