Publication: Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy
Date
2008
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following
laparoscopic surgeries. This study was aimed at comparing the ef cacies of Ondansetron-Dexamethasone combination
with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under
general anaesthesia.
Materials and methods: Hundred and fty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective,
randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg
Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized
balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were
assessed at six, 12 and 24 hrs post operation. Complete response was de ned as no PONV in 24 hrs and need for rescue
antiemetic was considered as failure of prophylaxis. Pain scores, time to rst analgesia demand, amount of Meperidine
consumption, adverse event(s) and duration of hospital stay were recorded.
Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics
were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Signi cantly high incidence of
vomiting and failure of prophylaxis (19.1%) occurred in group D during the rst six hrs (P=0.023 versus O & 0.008
versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD
(P=0.032).
Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV
after laparoscopic cholecystectomy. Dexamethasone alone is signi cantly less effective in preventing early vomiting
compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as
compared with combination therapy.
Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative
nausea and vomiting (PONV)
Description
Gautam B1, Shrestha BR 2, Lama P3, Rai S 3
1Lecturer, 2 Assistant professor, 3 Medical Of cer, Department of Anaesthesiology and Intensive Care, Kathmandu Medical College, Sinamangal, Nepal.