EFFECT OF PREDNISOLONE ON THE SYSTEMIC RESPONSE AND WOUND-HEALING AFTER COLONIC SURGERY

Objective: To study the effect of preoperative treatment with a single high-dose glucocorticoid on the systemic and immunologic responses, w ound healing, and convalescence after colonic surgery. Design: Double- blind, placebo-controlled, randomized trial. Setting: Department of su rgery in a university hospital. Patients: Thirty patients scheduled fo r open colonic resection; 6 patients were excluded from the study (N=2 4). interventions: Patients were randomized to either of 2 treatment r egimens: methylprednisolone sodium succinate 90 minutes before inducti on of anesthesia and epidural analgesia (group 1, n=12), or placebo 90 minutes before anesthesia and epidural analgesia (group 2, n=12). Mai n Outcome Measures: Assessments of pain, pulmonary function, convalesc ence, and various injury and wound-healing factors were done several t imes until 10 days after surgery. Results: Conventional reduction in p ulmonary function and mobilization was improved in group 1. Interleuki n-6 and C-reactive protein levels increased significantly less in grou p 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activations were significantly less pronounced in grou p 1. Reduction of collagen turnover was observed in group 1, but witho ut detrimental effects on collagen accumulation. Conclusion: Treatment with a single high-dose glucocorticoid before colonic surgery may imp rove postoperative pulmonary function and mobilization and reduce plas ma cascade system activations, the inflammatory response, and immunofu nction, but without detrimental effects on wound healing.