Effect of prednisolone on the systemic response and wound healing after colonic surgery
S. Schulze, J. Andersen, H. Overgaard, P. Norgard, H. J. Nielsen, A. Aasen, F. Gottrup and H. Kehlet
Department of Surgery, Sundby Hospital, Copenhagen, Denmark.
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.