Publication: Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis
Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Postoperative nausea and vomiting is a common distressing problem in patients
undergoing gynaecological surgery under anaesthesia including central neuraxial
blockade, which requires frequent medical interventions.
Objectives
We aimed to find out the antiemetic effect of prophylactic dexamethasone for
prevention of postoperative nausea and vomiting in patients undergoing total
abdominal hysterectomy under subarachnoid block. Influences of dexamethasone
on patient satisfaction and postoperative analgesia were also observed as
secondary objectives.
Methods
This was a prospective, randomized, double blind, placebo controlled study
conducted in BPKIHS, a Tertiary care University based hospital from January 2009
to April 2009, for a period of four months. This study involved 80 American Society
of Anaesthesiologist Physical Status I&II patients undergoing total abdominal
hysterectomy under subarachnoid block. Patients were divided into two groups of
40 each to receive either 4 mg of dexamethasone (group D) or normal saline (group
N) in volume of 2 ml intravenously 1 hourr prior to subarachnoid block. Surgery
was allowed to start with block height of at least T8 dermatome. Intraoperative and
postoperative nausea and vomiting was observed using nausea and vomiting scale
every 4 hour for 24 hours.
Results
Seven (17.4%) patients in group D and 11 (27.5%) patients in group N had nausea
and vomiting in the intraoperative period (P=0.284). Sixteen (40%) patients in
group D experienced nausea and vomiting in the postoperative period as compared
to 27 (67.5%) in group N (P =0.0136). Accordingly, the mean requirement of rescue
antiemetic was less in group D compared to Group N (P=0.042). Further, only 15
(37.5%) patients in group D required postoperative supplemental analgesic as
compared to 23 (57.5%) in group N (P=0.058). After 24 hrs of surgery, 26 (65%)
patients expressed satisfaction in group D as compared to 16 (40.0%) in group N
(P =0.025).
Conclusions
Use of dexamethasone prior to subarachnoid block in patients undergoing total
abdominal hysterectomy significantly reduces the incidence of nausea and vomiting
and the requirement of antiemetic in the postoperative period, with better patient
satisfaction.
KEY WORDS
Dexamethasone, gynaecological surgery, postoperative nausea and vomiting,
subarachnoid block
Description
Khatiwada S,1 Bhattarai B,1 Biswas BK,2 Pokharel K,1 Acharya R,3 Singh SN,1 Uprety D4
1Department of Anaesthesiology and Critical Care, BPKIHS, Dharan, Nepal
2Department of Anaesthesiology, NEIGRIHMS, Shillong, India
3Department of Otorhinolaryngology and head and neck surgery, Nobel Medical College, Biratnagar, Nepal
4Department of Obstetrics and Gynaecology, BPKIHS, Dharan, Nepal