Dexamethasone facilitates discharge after outpatient anorectal surgery

Corticosteroids can decrease pain and postoperative nausea and vomiting aft er ambulatory surgery. Therefore, we designed a study to evaluate if the ro utine use of dexamethasone would facilitate the early recovery process afte r anorectal surgery. A secondary aim of the study was to determine if dexam ethasone would increase the incidence of postoperative wound complications. Eighty adult outpatients undergoing anorectal surgery with a standardized monitored anesthesia care technique were randomly assigned to receive eithe r dexamethasone 4 mg IV or an equal volume of saline before the start of su rgery. All patients were premedicated with midazolam 2 mg IV and received k etorolac 30 mg IV as a preemptive analgesic. A propofol infusion, 50 mug.kg (-1).min(-1) IV, was initiated and subsequently titrated to maintain an obs erver's assessment of alertness/sedation score of 2 or 3 (with 5 = awake/al ert to 1 = asleep). Fentanyl 25 mug IV was administered 3-5 min before infi ltrating the surgical field with a 30-mL local anesthetic mixture containin g 15 mt of Lidocaine 1% and 15 mt of bupivacaine 0.25% (with epinephrine 1: 200,000 and sodium bicarbonate 3 mt). All patients were fast-tracked direct ly from the operating room to the step-down recovery area. Even though the incidences of postoperative pain and postoperative nausea and vomiting were small in both treatment groups, the time to "home readiness" was significa ntly shorter in the dexamethasone group. Importantly, there was no increase in the incidence of wound infections (8% vs 12%) or hematoma formation (3% vs 5%) in the dexamethasone (versus saline) group. We conclude that the ad ministration of dexamethasone, 4 mg IV, shortened the time to home readines s without increasing the incidence of postoperative wound infections in a h igh-risk outpatient population undergoing anorectal surgery.