• Ignazio Tarantino, Rene Warschkow, Ulrich Beutner, Walter Kolb, Andreas Lüthi, Cornelia Lüthi, Bruno M Schmied, and Thomas Clerici.
• *Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany †Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany ‡Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland §Department of Anesthesiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
• Ann. Surg. 2015 Dec 1;262(6):934-40.

ObjectiveDoes dexamethasone given before thyroidectomy reduce postoperative nausea and vomiting (PONV) in a randomized controlled trial?BackgroundPONV is an unsettling problem that commonly occurs in patients after thyroidectomy. Various preventive measures have been studied; however, many of these studies have been criticized for their biases (eg, use of opioids, sex selection) or were even retracted.MethodsThis single-institution, randomized, double-blind, placebo-controlled, superiority study was performed between January 1, 2011, and May 30, 2013. Patients undergoing thyroidectomy for benign disease were allocated by a block randomized list to receive a preoperative single dose of dexamethasone (8 mg) or placebo. Patients and staff were blinded to the treatment assignment. The primary endpoint was the incidence of PONV assessed at 4, 8, 16, 24, 32, and 48 hours after surgery. To observe an incidence reduction of 50%, a total of 152 patients were required for the study.ResultsThe total incidence of PONV was reported in 65 of 152 patients (43%; 95% confidence interval [CI], 35-51). In the intention-to-treat analysis, PONV occurred in 22 of 76 patients (29%; 95% CI, 20-40) in the treatment arm and in 43 of 76 patients (57%; 95% CI, 45-67) in the control arm (P = 0.001; odds ratio = 0.31; 95% CI, 0.16-0.61; absolute risk reduction = 28%; 95% CI, 12-42). The number needed to treat was 4. No severe dexamethasone-related adverse events were observed during the study.ConclusionsA single dose of preoperative dexamethasone administration is an effective, safe, and economical measure to reduce PONV incidence after thyroidectomy.

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