Comparison of Intraperitoneal Versus Intravenous Dexamethasone on Postoperative Pain, Nausea, and Vomiting After Laparoscopic Cholecystectomy

Abstract

Background: Despite all of the benefits provided by laparoscopic cholecystectomy, such as rapid recovery and shorter hospital stay for patients, the incidence of postoperative nausea and vomiting (PONV) and postoperative pain (POP) still remains high. Objectives: This study was designed to compare the effects of intraperitoneal (IP) and intravenous (IV) dexamethasone on the reduction of PONV and POP. Methods: This prospective, randomized, double-blind clinical trial was conducted on a study population of 86 adult patients who were scheduled for laparoscopic cholecystectomy with the American Society of Anesthesiologists class I-II. The patients were randomized into three groups, namely IP dexamethasone (n = 29), IV dexamethasone (n = 29), and control (n = 28) groups. The patients were followed for clinical outcomes, including PONV, POP, and consumption of antiemetics, and their hemodynamic status during the first 24 hours after the surgery. Results: In the first 24 hours after the operation, no significant differences were observed in nausea (P = 0.41) and vomiting (P = 0.38) between the IP and IV dexamethasone groups. However, there was a lower severity of nausea in the IP group (P = 0.001). Additionally, the visual analog scale score representing POP was significantly reduced in the IP group (P = 0.02). No significant differences in the hemodynamic status were observed after the operation between all the three groups. Conclusions: The administration of 8 mg IP dexamethasone was associated with significantly reduced pain and severity of nausea, but not PONV, after laparoscopic cholecystectomy.

Analgesic Efficacy of Foot and Hand Massage for Laparoscopic Cholecystectomy: A Meta-Analysis

“…Pharmacological and nonpharmacological supplementary methods are developed to alleviate pain after laparoscopic cholecystectomy [14,15]. Pharmacological methods commonly lead to negative impact on vital functions like respiratory, nervous, urinary, and gastrointestinal systems [14,[16][17][18][19][20]. The massage application is one preferred application among nonpharmacological supplementary methods because it is a low-cost, less time consuming, easy-to-apply, and effective method for pain control [21].…”

Efficacy of dexamethasone in prevention of postoperative nausea and vomiting in laparoscopic cholecystectomy.

“…9 In another study, intraperitoneal dexamethasone administration reduced post-LC severity of nausea and pain, but not PONV. 10 PONV remains a huge problem in patients undergoing LC. It makes them uneasy and makes them go through discomfort after the surgery.…”

The Efficacy of Foot Massage for Pain Relief of Laparoscopic Cholecystectomy: A Meta-analysis Study

“…Currently, pharmacological methods are used to alleviate postoperative pain in patients undergoing laparoscopic cholecystectomy, but they may cause respiratory depression, itching, nausea, vomiting, and decreased gastrointestinal motility 9–13. Complementary and alternative therapies have important potential in pain relief 14.…”