Dexamethasone Reduces Emesis After Major gastrointestinal Surgery


DREAMS is a double-blinded multi-centre randomised controlled trial assessing the effect of dexamethasone on post operative nausea and vomiting in abdominal surgery.

Dexamethasone has been widely used during surgery such as laparoscopic cholecystectomy and there has been much published about its beneficial effects on postoperative pain, nausea and vomiting.

Preoperative Dexamethasone is now considered (part of) the best standard of care for patients undergoing major GI colorectal surgery to improve post-operative recovery. It is believed to be effective because of its effects on inflammation, appetite, gastric emptying and vomiting. 4 randomised controlled trials have been performed which have shown benefits particularly in terms of reduced post-operative nausea and vomiting. Unfortunately, all of these trials are single-centre; the total number of patients randomised in all the trials is only 390 patients, of whom 100 underwent colorectal surgery.

Dexamethasone has significant side effects and can potentially adversely affect outcome from surgery. Its potential benefits for patients undergoing colorectal resection should be demonstrated within a randomised multi-centre trial and these benefits should be demonstrated both inside and outside of an enhanced recovery programme.

Aims of the study
DREAMS seeks to investigate whether dexamethasone decreases post-operative nausea and vomiting (PONV) in patients undergoing major colorectal surgery. The primary endpoint of the study is PONV evaluated using a patient-completed, validated questionnaire, and objective measurement through the use of post-operative anti-emetics.
Secondary aims of this study seek to evaluate how improvements in post-operative nausea and vomiting might influence the patients’ general recovery. It will be measured in terms of length of stay in hospital, time to eating solid food, passage of flatus and colonic function, as well as measurement of fatigue using a validated questionnaire.

DREAMS has its own website at

Please contact the TMG with queries: Reena Ravikumar, Mei Ju Hwang, Emma Mowatt, Nazzia Mirza, David Bartlett, Elizabeth Hepburn