Comparison Effect of Promethazine/Dexamethasone and Metoclopramide /Dexamethasone on Postoperative Nausea and Vomiting after Laparascopic Gastric Placation: A Randomized Clinical Trial

Abstract

BackgroundLaparoscopic gastric plication (LGP) is a technique in the restrictive category of bariatric procedures that reduces the gastric volume and increases intragastric pressure. Nausea and vomiting are the most common complications after this procedure. The goal of this research is to compare the combined effect of promethazine/dexamethasone versus Metoclopramide/ dexamethasone on the prevention of nausea and vomiting after LGP.MethodsIn recovery, the patients were divided into two groups, the Metoclopramide group which was given Metoclopramide 10 mg plus dexamethasone 4 mg/8 hours intravenous for 48 hours, and the promethazine group which was given promethazine 50 mg /12 hours, intramuscular for the first 24 hours and then promethazine 25 mg/12 hours for the next 24 hours plus dexamethasone 4 mg/8 hours intravenous for 48 hours. The frequency of nausea and vomiting, number of reflux episodes, frequency of epigastric fullness, and the duration of walking around q12 hours were recorded in the first 48 hours post-operation.ResultsEighty patients were enrolled into the study. Promethazine group were found to significantly reduce the incidence of PONV in the first 24 hours compared with the other group (41% vs. 97.5%), relative risk = 0.042 [95% CI = 0.006, 0.299]. The mean numbers of epigastric fullness and severity of epigastria pain were lower in the promethazine group (P = 0.01) and the total opioid requirement was also reduced in promethazine group (32.1 ± 2.6 VS .68.5 ± 4.6 mg). However, the patients in the promethazine group were more sedated, which caused the duration of walking q12 hours in this group to decrease.ConclusionsIn morbidly obese patients undergoing laparoscopic gastric plication, promethazine/dexametasone was more effective than Metoclopramide/dexametasone in preventing and reducing the incidence of nausea, epigastric fullness, and reflux. That combination was also more effective than Metoclopramide in reducing the severity of epigastric pain.

The Clinical Observation on PONV with the Intervention of Thumbtack Needles Combined with Chinese Medicine Ironing Therapy

“…Postoperative nausea and vomiting (PONV) is defined as a postoperative gastrointestinal dysfunction, with mild PONV documented to have a negative impact on nutritional intake and comfort, and severe PONV leading to water-electrolyte disturbances, wound rupture, aspiration risk, and aspiration pneumonia [ 1 ]. It has a certain detrimental effect on postoperative recovery, and further takes a toll on patients' health and medical expenditure [ 2 ]. The incidence of PONVs induced by various surgeries is estimated to be 15%–46.1% [ 3 , 4 ].…”

Effects of ondansetron, metoclopramide and granisetron on perioperative nausea and vomiting in patients undergone bariatric surgery: a randomized clinical trial

“…Metoclopramide belongs to the group of medications known as dopamine-receptor antagonists and is widely used as an antiemetic. However, metoclopramide alone is used as an antiemetic for PONV prophylaxis [12], but it is seems that several clinicians use it as a rescue antiemetic [13]. Interestingly, although these two drugs alone are well known, the combination of the two has been less commonly used in PONV after bariatric surgery (see Appendix).…”

Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial

“…Cho et al proposed that prophylactic administration of 2.5-5 mg dexamethasone can reduce the frequency of PONV, lower visual analog pain scores, facilitate recovery to home readiness, and improve satisfaction in outpatients undergoing anorectal surgery [17]. Talebpour et al concluded that dexamethasone-promethazine was more effective in reducing PONV and pain than metoclopramidepromethazine combination in patient undergoing laparoscopic gastric placation [18]. Ahsan et al found a combination of ondansetron with dexamethasone more efficacious than ondansetron alone in preventing PONV after laparoscopic cholecystectomy [19].…”