Post operative nausea and vomiting after laparoscopic cholecystectomy: comparison of prophylactic effect of dexamethasone with ondansetron (original) (raw)
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Journal of the College of Physicians and Surgeons, 2008
To compare the efficacy of combination of dexamethasone plus ondansetron with dexamethasone alone for postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Double blinded randomized controlled clinical trial. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Dow University of Health Sciences and Civil Hospital, Karachi, from March 2007 to September 2007. One hundred patients, both male and female, age 20 to 50 years, ASA Physical status I and II, scheduled for elective laparoscopic cholecystectomy under general anaesthesia were randomly allocated to two groups. Group A received dexamethasone (2 ml) plus ondansetron 4 mg (2 ml) prepared in two different syringes, and group B received dexamethasone 8 mg (2 ml) and normal saline (2 ml), prepared in two separate syringes just before induction of anaesthesia. Anaesthesia was standardized. For the first 24 hours after anaesthesia, the presence or absence of nausea and vomitin...
Journal of Evolution of Medical and Dental Sciences, 2019
BACKGROUND Postoperative nausea and vomiting (PONV) have been described as the "big little problem" 1,2 for anaesthesiology for laparoscopic surgery. Commonest cause of morbidity after aesthesia and surgery are pain and postoperative nausea vomiting. 3,4,5 METHODS Institutional ethical committee clearance and written informed consent were obtained from 60 female patients of American Society of Anaesthesiologists physical status I and II, aged between 18 to 65 years, weighing about 50-60 Kg., height 150 to 160 cm, scheduled for laparoscopic cholecystectomy (duration < 90 minutes) under general anaesthesia in this prospective, randomised, double blind controlled study. Patients coming to operation theatre were divided by computer generated randomization in to two groups of 30 each, Group-A (n=30) and Group-B (n=30). A person, who was blind to the randomisation schedule, was administered the study drug 1 minute prior to other I.V. drugs. One of the following regimens, for Group A patients: Ondansetron 4 mg in 2 ml or for Group B patients: Dexamethasone 8 mg in 2 ml were administered. After preoxygenation, general anaesthesia was administered, pneumoperitoneum created, laparoscopic cholecystectomy done, and anaesthesia reversed. For post-operative analgesia Paracetamol (1000 mg) I.V. was administered. All patients were observed post operatively by noting vital signs and complications, if any. All episodes of PONV (nausea, vomiting, retching) were recorded for 12 hrs post operatively. Rescue drug Inj. Metoclopramide 10 mg I.V. was given, if required. All data from each patient was obtained and tabulated. RESULTS The age, weight, height, ASA status and duration of surgery of the patients included in study group (p ≤0.05) were comparable and there was no significant statistical difference among the data collected during the study. Incidence of nausea is higher in both groups in the first hour though it is not statistically significant. Within 3-6 hours, patients receiving Dexamethasone had higher incidence of nausea, but it is not statistically significant. Incidence of retching is higher in both groups in the first hour. It is not statistically significant. Vomiting was more in the first 3 hours in both groups. It was not statistically significant. Need for rescue drug (Inj. metoclopramide 10 mg I.V.) was similar in both groups. CONCLUSIONS Ondansetron is as effective as Dexamethasone in reducing the incidence of nausea and vomiting in post-operative period of laparoscopic cholecystectomy and has minimal side effects.
Patients undergoing general anesthesia for laparoscopic cholecystectomy have a high incidence of post-operative nausea and vomiting (PONV) .Combination of dexamethasone and ondansetrone is more effective than the treatment of PONV following the laparoscopic cholecystectomy. Background: Post-operative nausea and vomiting (PONV) are the most common unpleasant experiences following laparoscopic surgeries. Objectives: In the current research, compared the effect of dexamethasone and ondansetrone combined and separately on preventing nausea and vomiting in the patients undergone elective surgery with general anesthetic using laparoscopic cholecystectomy procedure. Patients and Methods: One hundred fifty patients with ASA class I and II aged between 20-65 years voluntarily participated in this double-blind randomized prospective study. The patients were randomly divided into three groups of 50. All the participants faced general anesthetic procedure whereas each group received different treatment regimen as follow: the O-group, 4 mg ondansetrone, the D-group, 8 mg dexamethasone, and the OD-group, combination of 4 mg of ondansetrone plus 8 mg dexamethasone. Every episode of PONV and the need for antiemetic drug were evaluated 6 hours following the operation and then every 6 hours up to 24 hours after the operation. The complete response was defined as the case with no episode of PONV within the 24 hours and the need for anti-vomiting cases was defined as the failure in prophylaxis. Results: The complete response was observed in 62.2, 68.2 and 89.6 percent of O, D, and OD groups, respectively. The frequency of complete response was significantly lower in OD-group (P = 0.011 vs. the D and P = 0.005 vs. the O group). The need for the antiemetic drug in groups O, D, and OD was 28.3, 22.8, and 6.2, respectively. The incidence of vomiting and failure in prophylaxis was observed in D-group during the first six hrs. The highest need for the anti-vomiting drug within the 6 to 24 hours of post operation was observed in group O compared to the group OD (P = 0.012). Conclusions: Combination of dexamethasone and ondansetrone is more effective than the treatment of PONV by each of these drugs separately following the laparoscopic cholecystectomy .The application of dexamethasone alone in preventing premature PONV is less effective than the application of ondansetrone or the combination of these two drugs. In addition, ondansetrone alone is less effective than the combination of these two drugs in preventing PONV.
JPMA. The Journal of the Pakistan Medical Association, 2014
OBJECTIVE To compare the efficacy of ondansetron alone and combination of ondansetron and dexamethasone in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. METHODS The randomised control trial was conducted from April 23 to August 22, 2009, at the Liaquat National Hospital, Karachi, and comprised 100 American Society of Anaesthesiology I and II patients undergoing laparoscopic cholecystectomy. Half of the subjects comprised Group A and received ondansetron alone, while Group B received combination of ondansetron and dexamethasone. They were randomised by opaque envelope method. Group A received ondansetron 4 mg while Group B received ondansetron 4 mg with dexamethasone 8 mg, 1 minute before induction. Post-operatively patients were observed for six hours for any episode of nausea or vomiting, or whether the patients required any rescue anti emetic. SPSS 19 was used for statistical analysis. RESULTS Patients receiving ondansetron alon...
The Professional Medical Journal
Objective: To evaluate the efficacy of intravenous dexamethasone in comparison with control group for the prevention of po3stoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Study Design: Randomized controlled study. Setting: Department of Surgery, Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan. Period: 1st November 2022 to 31st April 2023. Material & Methods: A total of 120 patients of prospective laparoscopic cholecystectomy from both genders in ages between 18-60 years were randomized into two equal groups A and B. Group A subjects were administered with 4 mg IV dexamethasone preoperatively while group B patients were control subjects. The primary outcome was set as the reduced PONV after surgery. It was assessed through VAS scores and recorded at different time intervals. The final outcome was measured at 24th hour. Rescue antiemetic was administered whenever VAS score became > 5. Results: At 24 hours after surgery, VAS score was 0.57...
Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the ef¿ cacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and ¿ fty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was de¿ ned as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to ¿ rst analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Signi¿ cantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the ¿ rst six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is signi¿ cantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy.