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Effect of Prednisolone on the Systemic Response and Wound Healing After Colonic Surgery
Svend Schulze, MD, DMSc;
Jens Andersen, MD;
Helle Overgaard, MD;
Peter Nørgaard, MD;
Hans Jørgen Nielsen, MD, DMSc;
Ansgar Aasen, MD, DMSc;
Finn Gottrup, MD, DMSc;
Henrik Kehlet, MD, DMSc
Arch Surg. 1997;132(2):129-135.
Abstract
Objective
To study the effect of preoperative treatment with a single high-dose glucocorticoid on the systemic and immunologic responses, wound healing, and convalescence after colonic surgery.
Design
Double-blind, placebo-controlled, randomized trial.
Setting
Department of surgery in a university hospital.
Patients
Thirty patients scheduled for open colonic resection; 6 patients were excluded from the study (N=24).
Interventions
Patients were randomized to either of 2 treatment regimens: methylprednisolone sodium succinate 90 minutes before induction of anesthesia and epidural analgesia (group 1, n=12), or placebo 90 minutes before anesthesia and epidural analgesia (group 2, n= 12).
Main Outcome Measures
Assessments of pain, pulmonary function, convalescence, and various injury and wound-healing factors were done several times until 10 days after surgery.
Results
Conventional reduction in pulmonary function and mobilization was improved in group 1. Interleukin-6 and C-reactive protein levels increased significantly less in group 1, as delayed-type hypersensitivity was abolished in group 1. Plasma cascade system activations were significantly less pronounced in group 1. Reduction of collagen turnover was observed in group 1, but without detrimental effects on collagen accumulation.
Conclusion
Treatment with a single high-dose glucocorticoid before colonic surgery may improve postoperative pulmonary function and mobilization and reduce plasma cascade system activations, the inflammatory response, and immunofunction, but without detrimental effects on wound healing.
Arch Surg. 1997;132:129-135
Author Affiliations
From the Departments of Surgery (Drs Schulze, Andersen, and Overgaard) and Anesthesiology (Dr Nørgaard), Sundby Hospital, Copenhagen Hospital Corporation, Copenhagen, Denmark; the Department of Surgical Gastroenterology, Hvidovre Hospital, Copenhagen Hospital Corporation (Drs Nielsen and Kehlet); the Institute of Surgical Pathophysiology, Rikshospitalet, Oslo, Norway (Dr Aasen); and the Copenhagen Wound Healing Center, Bispebjerg Hospital, Copenhagen Hospital Corporation (Dr Gottrup).
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