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A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.
Anesth Analg. 2003 Jul; 97(1):259-63, table of contents.A&A

Abstract

In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) ondansetron 8 mg, and (c) dexamethasone 8 mg plus ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, ondansetron 8 mg, and dexamethasone 8 mg plus ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with ondansetron 4 mg has no added benefit compared with ondansetron 8 mg alone in the prophylaxis of PONV and pruritus.

IMPLICATIONS

Postoperative nausea and vomiting (PONV) and pruritus are common side effects after spinal opioid administration. In this study, dexamethasone 8 mg plus ondansetron 4 mg was as effective as ondansetron 8 mg. The administration of dexamethasone alone was associated with a frequent incidence of PONV, demonstrating a lack of efficacy. This has important cost implications.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland. szarvasszilvia@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12818978

Citation

Szarvas, Szilvia, et al. "A Comparison of Dexamethasone, Ondansetron, and Dexamethasone Plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Major Orthopedic Surgery." Anesthesia and Analgesia, vol. 97, no. 1, 2003, 259-63, table of contents.
Szarvas S, Chellapuri RS, Harmon DC, et al. A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesth Analg. 2003;97(1):259-63, table of contents.
Szarvas, S., Chellapuri, R. S., Harmon, D. C., Owens, J., Murphy, D., & Shorten, G. D. (2003). A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesthesia and Analgesia, 97(1), 259-63, table of contents.
Szarvas S, et al. A Comparison of Dexamethasone, Ondansetron, and Dexamethasone Plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Major Orthopedic Surgery. Anesth Analg. 2003;97(1):259-63, table of contents. PubMed PMID: 12818978.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. AU - Szarvas,Szilvia, AU - Chellapuri,Ramesh S, AU - Harmon,Dominic C, AU - Owens,John, AU - Murphy,Damian, AU - Shorten,George D, PY - 2003/6/24/pubmed PY - 2003/7/18/medline PY - 2003/6/24/entrez SP - 259-63, table of contents JF - Anesthesia and analgesia JO - Anesth Analg VL - 97 IS - 1 N2 - UNLABELLED: In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) ondansetron 8 mg, and (c) dexamethasone 8 mg plus ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, ondansetron 8 mg, and dexamethasone 8 mg plus ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with ondansetron 4 mg has no added benefit compared with ondansetron 8 mg alone in the prophylaxis of PONV and pruritus. IMPLICATIONS: Postoperative nausea and vomiting (PONV) and pruritus are common side effects after spinal opioid administration. In this study, dexamethasone 8 mg plus ondansetron 4 mg was as effective as ondansetron 8 mg. The administration of dexamethasone alone was associated with a frequent incidence of PONV, demonstrating a lack of efficacy. This has important cost implications. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/12818978/A_comparison_of_dexamethasone_ondansetron_and_dexamethasone_plus_ondansetron_as_prophylactic_antiemetic_and_antipruritic_therapy_in_patients_receiving_intrathecal_morphine_for_major_orthopedic_surgery_ L2 - https://doi.org/10.1213/01.ane.0000066310.49139.2a DB - PRIME DP - Unbound Medicine ER -