Effects of prophylactic dexamethasone on postoperative nausea and vomiting in scoliosis correction surgery: a double-blind, randomized, placebo-controlled clinical trial

Abstract

Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58–0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.

Effect of single-dose intravenous dexamethasone on postoperative pain and postoperative nausea and vomiting in patients undergoing lower segment cesarean section under spinal anesthesia

“…On the basis of these findings, the authors concluded that single dose of intravenous dexamethasone is effective in reducing post-operative pain as well as PONV. 10 Similar beneficial effects of intravenous dexamethasone on the occurrence of PONV are also reported by the authors such as De Oliveira Jr et al, 11 and Henzi et al 12 Single dose of intravenous dexamethasone in otherwise healthy individuals is less likely to alter hemodynamic stability of the patients and virtually does no harm to the patients. Many authors reported that while single dose of dexamethasone is effective in reducing post operative pain as well as incidence of nausea and vomiting it doesn't have any harmful effect on hemodynamic stability of the patients.…”

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“… 152 found that dexamethasone 4–5 mg was equally as effective as 8–10 mg in terms of antiemetic efficacy. Dexamethasone antiemetic efficacy alone or in combination has been reported in patients undergoing laparoscopic cholecystectomy 153 – 164 , other abdominal laparoscopic procedures 150 , breast cancer surgery 165 , large and small bowel surgery 166 , total knee arthroplasty 167 , joint replacement surgery 168 , gynecological laparoscopic procedures 169 , 170 , cesarean delivery 171 , scoliosis correction surgery 172 , vitrectomy under local anesthesia 173 , and upper extremity surgery 174 as well as in endoscopic adenoidectomy 175 and strabismus correction surgery 176 in children. Interestingly, there are reports that dexamethasone did not reduce PONV in patients undergoing surgery for facial fracture 177 , laparoscopic surgery for suspected appendicitis 178 , and microvascular decompression surgery of the trigeminal nerve root 179 .…”

Application of dexamethasone combined with tranexamic acid in perioperative period of total hip arthroplasty

“…The antiemetic effect of DEXA has been confirmed, mainly by regulating prostaglandin synthesis or inhibiting endogenous opioid release. [ 30 , 31 ] In the current study, using a single dose of a glucocorticoid to reduce the incidence of PONV was supported and recommended. [ 20 , 21 ] We also hypothesized that patients would receive PONV remission 24 hours after surgery if the additional dose was supplied compared with single-dose treatment.…”