Comparison of ondansetron and combination of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery

SUMMARYObjective: Various drugs have been used as antiemetics for treatment of postoperative nausea and vomiting. The present study was undertaken to assess the efficacy of ondansetron and dexamethasone for preventing postoperative nausea and vomiting in children undergoing tonsillectomies. Method: Sixty children having ASA physical status Grade I or II in the age group 4-12 years undergoing tonsillectomy under general anaesthesia were included in the study. These were allocated to three groups of twenty patient each. After induction patients were given test solution A (2 mL) comprising of normal saline or dexamethasone 500 µg/kg or 150 µg/kg in Group I, II and III respectively. At the end of surgery before switching off anaesthetics, test solution B (2 mL) was given comprising of ondansetron 0.15 mg/kg (maximum upto 4 mg) or normal saline or ondansetron 0.1 mg/kg (maximum upto 2 mg). Postoperatively incidence of nausea, number of vomiting episodes, frequency of administration of rescue antiemetic and analgesic were recorded. Results: In Group II 80% of patients had nausea as compared to 70% in Group I and 50% in group III and the difference between Group II and III was statistically significant (p<0.05). 30% of the patients had vomiting in Group I and II and only 15% of the patients in Group III. The frequency of rescue analgesic among the three groups was comparable except at 0.5 hours. 50% of patients showed complete response in Group III, as compared to 30% and 20% in Group I and Group II respectively. Conclusion:The combined regimen of ondansetron with dexamethasone was more efficacious as an antiemetic in controlling postoperative nausea and vomiting in children undergoing tonsillectomy. Keywords: Postoperative nausea and vomiting, dexamethasone, ondansetron, tonsillectomy ÖZET Amaç: Postoperatif bulantı ve kusmanın tedavisi için antiemetic olarak çeşitli ilaçlar kullanılmaktadır. Bu çalışmada tonsillektomi yapılan çocuklarda postoperative bulantı ve kusmayı önlemek için ondansetron ve deksametazonun etkinliği değerlendirilmektedir. Yöntem: Genel anestezi altında tonsillektomi yapılan 4-12 yaşları arasında Grade I ve Grade II ASA fiziksel durumuna sahip 60 çocuk çalışmaya dahil edildi. Bunlar her biri 20'şer kişiden oluşan üç gruba ayrıldı. İndüksiyondan sonra sırasıyla Grup I, Grup II ve Grup III'deki hastalara normal salin ya da deksametazon 500 µg/kg ya da 150 µg/kg'dan oluşan test solüsyonu A (2 mL) verildi. Cerrahinin sonunda, anestezikleri "switch" yapmadan önce test solüsyonu B (2 mL) At the end of surgery before switching off anaesthetics, ondansetron 0.15 mg/kg (maksimum 4 mg) ya da 214 CMJCumhuriyet Medical Journal normal salin ya da ondansetron 0.1 mg/kg (maksimum 2 mg)'dan oluşan test solüsyonu B (2 mL) verildi. Postoperatif bulantı ve kusma sayısı, antiemetic ve analjezik uygulama sıklığı kaydedildi. Bulgular: Grup II'de hastaların %80'inde, Grup I'deki %70 ve Grup III'deki %50 ile karşılaştırıldığında bulantıya sahipti. Grup II ve III arasındaki fark istatistiksel olarak anlamlı idi (p<0.05)....

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“…The results of our study are in agreement with other studies conducted by various authors [12][13][14][15][16][17] .…”

Section: Discussionsupporting

confidence: 83%

A study to compare dexamethasone and ondansetron for preventing postopera-tive nausea and vomiting in children undergoing tonsillectomy

Saini¹,

Mehta²,

Bansal³

et al. 2015

Cumhuriyet Med J

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“…This is comparable to the study conducted by Bhattarai et al 12 and Panda et al 14 . Lopez-Olando et al 15 concluded that prophylactic administration of a combination of dexamethasone and ondansetron is effective in In this study, ondansetron 4 mg was used as rescue anti emetic in both the groups.…”

supporting

confidence: 81%

“…The mechanism of action of dexamethasone is unknown; however there have been some suggestions, such as central/ peripheral inhibition of production of 5 HT, central inhibition of synthesis of prostaglandins, or changes in permeability of the blood brain barrier to serum protein 7,12 . The major concern regarding use of dexamethasone is infection, delayed wound healing and other side effect.…”

mentioning

confidence: 99%

Comparison of ondansetron used alone and in combination with dexamethasone as a prophylaxis for postoperative nausea and vomiting following laparoscopic cholecystectomy

Sanjowal¹,

Biswas²,

Saha³

2015

Faridpur Med Coll J

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:Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence can be as high as 76% which would cause unexpected delay in hospital discharge. This study was designed to compare the efficacy of the ondansetron alone with combination of ondansetron and dexamethasone the given as prophylaxis for PONV in patients undergoing laparoscopic cholecystectomy. One hundred patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into 2 groups of 50 each. Group I received 4mg of ondansetron intravenously (iv), whereas Group II received ondansetron 4mg and dexamethasone 4mg just before induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic. Complete response defined as no nausea and vomiting during first 24 hours, was noted in 76% of patients in Group I and in 92% of patients in Group II. Rescue anti emetic requirement was less in Group II (4%) than Group I (20%). So it can be concluded that the combination of ondansetron and dexamethasone is more effective in preventing PONV in patients undergoing laparoscopic cholecystectomy than ondansetron alone.

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“…D'Souza et al compared dexamethasone with ondansetron for the prevention of PONV after laparoscopic gynecologic surgery and found that dexamethasone decreased the incidence of PONV and use of single dose of dexamethasone was safe, had a lesser cost and could be alternative to single dose ondansetron in this patient population 19 . Bhattarai et al compared use of ondansetron alone with combined use of 4 mg ondansetron plus 8mg dexamethasone in the control of PONV in patients undergoing laparoscopic surgery and found that the combined use of two agents was more effective 25 . The combination was also safe and well tolerated by the patients.…”

Section: Discussionmentioning

confidence: 99%

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

Demırhan¹,

Tekelioglu²,

Akkaya³

et al. 2013

Afr H. Sci.

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Background: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. Objective: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. Methods: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. Results: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups(p>0.05). Conclusion: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

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Comparison of ondansetron and combination of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery

Cited by 28 publications

References 12 publications

A study to compare dexamethasone and ondansetron for preventing postopera-tive nausea and vomiting in children undergoing tonsillectomy

A study to compare dexamethasone and ondansetron for preventing postopera-tive nausea and vomiting in children undergoing tonsillectomy

Comparison of ondansetron used alone and in combination with dexamethasone as a prophylaxis for postoperative nausea and vomiting following laparoscopic cholecystectomy

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

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