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Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy.
Kathmandu Univ Med J (KUMJ). 2008 Jul-Sep; 6(23):319-28.KU

Abstract

BACKGROUND

Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the efficacies 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 fifty 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 defined as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to first 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. Significantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the fi 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 significantly 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.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care, Kathmandu Medical College, Sinamangal, Nepal. gautambinod2060@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20071813

Citation

Gautam, B, et al. "Antiemetic Prophylaxis Against Postoperative Nausea and Vomiting With Ondansetron-dexamethasone Combination Compared to Ondansetron or Dexamethasone Alone for Patients Undergoing Laparoscopic Cholecystectomy." Kathmandu University Medical Journal (KUMJ), vol. 6, no. 23, 2008, pp. 319-28.
Gautam B, Shrestha BR, Lama P, et al. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008;6(23):319-28.
Gautam, B., Shrestha, B. R., Lama, P., & Rai, S. (2008). Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu University Medical Journal (KUMJ), 6(23), 319-28.
Gautam B, et al. Antiemetic Prophylaxis Against Postoperative Nausea and Vomiting With Ondansetron-dexamethasone Combination Compared to Ondansetron or Dexamethasone Alone for Patients Undergoing Laparoscopic Cholecystectomy. Kathmandu Univ Med J (KUMJ). 2008 Jul-Sep;6(23):319-28. PubMed PMID: 20071813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. AU - Gautam,B, AU - Shrestha,B R, AU - Lama,P, AU - Rai,S, PY - 2010/1/15/entrez PY - 2008/7/1/pubmed PY - 2010/6/10/medline SP - 319 EP - 28 JF - Kathmandu University medical journal (KUMJ) JO - Kathmandu Univ Med J (KUMJ) VL - 6 IS - 23 N2 - BACKGROUND: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the efficacies 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 fifty 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 defined as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to first 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. Significantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the fi 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 significantly 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. SN - 1812-2078 UR - https://www.unboundmedicine.com/medline/citation/20071813/Antiemetic_prophylaxis_against_postoperative_nausea_and_vomiting_with_ondansetron_dexamethasone_combination_compared_to_ondansetron_or_dexamethasone_alone_for_patients_undergoing_laparoscopic_cholecystectomy_ L2 - http://www.diseaseinfosearch.org/result/7414 DB - PRIME DP - Unbound Medicine ER -