Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery

Abstract

BackgroundOpioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery.MethodsOne hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery.ResultsThe number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance.ConclusionsCombination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.

Palonosetron and Ramosetron Compared for Effectiveness in Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis

“…Therefore, palonosetron has a significantly longer half-life (~40 hours) than dolasetron, granisetron, and ondansetron [5]. Ramosetron also shows a higher receptor affinity and longer duration of action than older agents in its class [6,7]. …”

Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

“…Ramosetron is a newly developed 5-HT 3 antagonist with higher receptor affinity and a longer duration of action than older agents in its class [ 7 , 10 ]. Dexamethasone enhances antiemetic efficacy, as well as reduces PAS and pain [ 3 , 11 , 12 ].…”

Ramosetron vs Ramosetron with Dexmedetomidine for Prevention of Postoperative Nausea Vomiting and Shivering after Gynaecological Laparoscopic Surgery: A Comparative Study

“…There is enough evidence in literature to show that combination antiemetics with different mechanisms of action act synergistically with a better control of PONV 18,19 . We used a combination of Ramosetron, which is a widely used 5-HT3 receptor antagonist; and dexmedetomidine, an alpha 2 agonist.…”