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AMBULATORY ANESTHESIA

Methylprednisolone Reduces Pain, Emesis, and Fatigue After Breast Augmentation Surgery: A Single-Dose, Randomized, Parallel-Group Study with Methylprednisolone 125 mg, Parecoxib 40 mg, and Placebo

Luis Romundstad, MD^*, Harald Breivik, MD, DMSc^*, Helge Roald, MD, DMSc, Knut Skolleborg, MD, Torleiv Haugen, MD, Jon Narum, MD, and Audun Stubhaug, MD, DMSc^*

*Department Group of Clinical Medicine, University of Oslo; Department of Anesthesiology, Rikshospitalet University Hospital; and Department of Plastic and ENT Surgery, Colosseum Clinic, Oslo, Norway

Address correspondence and reprint requests to Luis Romundstad, University of Oslo, Department Group of Clinical Medicine, Department of Anesthesiology, Rikshospitalet University Hospital, N-0027 Oslo, Norway. Address e-mail to luisro{at}medisin.uio.no.

We compared methylprednisolone 125 mg IV (n = 68) and parecoxib 40 mg IV (n = 68) with placebo (n = 68) given before breast augmentation surgery in a randomized, double-blind parallel group study. Surgery was performed under local anesthesia combined with propofol/fentanyl sedation. Methylprednisolone and parecoxib decreased pain at rest and dynamic pain intensity from 1 to 6 h after surgery compared with placebo (mean summed pain intensity_{1–6 h}: methylprednisolone [17.25; 95% confidence interval [CI], 14.85–19.65] versus placebo [21.7; 95% CI, 19.3–24.1]; P < 0.03; parecoxib [15.25; 95% CI, 13.25–17.25] versus placebo; P < 0.001; mean summed dynamic pain intensity_{1–6 h}: methylprednisolone [22.7; 95% CI, 20.1–23.3] versus placebo [28.4; 95% CI, 26.0–30.8]; P < 0.01; parecoxib [20.9; 95% CI, 18.6–23.2] versus placebo; P < 0.001). Both rescue drug consumption and actual pain (all observations before and after rescue) during the first 6 h were similar in the two active drug groups and significantly reduced compared with placebo. Using a composite score of actual pain intensity and rescue analgesic use, the active drugs were significantly superior to placebo (P < 0.001 for both active drugs). Postoperative nausea and vomiting was reduced after methylprednisolone administration (incidence, 30%), but not after parecoxib (incidence, 37%), during the first 24 h compared with placebo (incidence, 60%; P < 0.001). Fatigue was reduced by methylprednisolone (incidence, 44%), but not by parecoxib (incidence, 59%), compared with placebo (incidence, 66%; P < 0.05). In conclusion, methylprednisolone 125 mg IV given before breast augmentation surgery had analgesic and rescue analgesic-sparing effects comparable with those of parecoxib 40 mg IV. Methylprednisolone, but not parecoxib, reduced nausea, vomiting, and fatigue.

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