Comparison of the Effects of Moderate- and High-Dose Glucocorticoids on Postoperative Recovery

Laparoscopic cholecystectomy is one of the most commonly performed minimally invasive surgical procedures worldwide. Although it is associated with shorter hospital stay and faster recovery compared with open surgery, patients frequently experience postoperative pain, nausea, and delayed functional recovery. Effective perioperative strategies aimed at improving recovery and reducing postoperative complications remain an important component of enhanced recovery protocols.

Glucocorticoids, particularly dexamethasone, are widely used in perioperative care due to their anti-inflammatory, antiemetic, and analgesia-sparing properties. Perioperative dexamethasone administration has been shown to reduce postoperative nausea and vomiting (PONV) and may contribute to improved pain control and overall recovery. However, the optimal dose of dexamethasone for maximizing recovery outcomes while maintaining safety remains unclear.

This prospective randomized controlled study is designed to evaluate whether higher doses of intraoperative dexamethasone provide additional benefits in postoperative recovery compared with moderate doses or placebo in patients undergoing elective laparoscopic cholecystectomy. Patients undergoing elective surgery will be randomly assigned to receive either moderate-dose dexamethasone, high-dose dexamethasone, or placebo as part of perioperative management.

All patients will receive standardized anesthesia management and multimodal analgesia according to institutional practice. Postoperative recovery will be evaluated using patient-reported recovery quality scores, inflammatory markers, and commonly assessed clinical outcomes including postoperative nausea and vomiting, pain intensity, and analgesic requirements.

The findings of this study may help clarify the dose-response relationship of perioperative dexamethasone and provide evidence to guide optimal dosing strategies aimed at improving postoperative recovery after laparoscopic cholecystectomy.

Inclusion criteria

• Age between 18 and 65 years
• ASA physical status I-II
• Scheduled for elective laparoscopic cholecystectomy
• Undergoing general anesthesia
• Ability to provide written informed consent

Exclusion criteria

• Patients younger than 18 years or older than 65 years
• Known allergy to dexamethasone
• ASA physical status III or higher
• Surgical procedures lasting longer than 120 minutes
• Emergency surgeries
• Pregnant or breastfeeding patients
• Patients with coagulopathy or receiving anticoagulant therapy
• Known allergy to local anesthetics
• Localized infection at the injection site
• Inflammatory bowel disease
• Autoimmune diseses
• Chronic pain conditions
• Ocular herpes simplex infection
• Cushing's disease
• Myasthenia gravis
• Anticipated poor compliance with the study protocol
• Vaccination within the last 14 days
• Use of systemic glucocorticoids or immunosuppressive drugs
• İmpaired renal function (GFR < 30 mL/min)
• Liver cirrhosis
• Congestive heart failure
• Peripheral nerve disorders
• Elective laparoscopic cholecystectomy due to malignancy
• Conversion to open surgery during the operation
• Epilepsy
• Body mass index (BMI) > 30 kg/m²