Dexamethasone and Ondansetron for postoperative nausea and vomiting (PONV) following laparoscopic cholecystectomy a randomised control study (original) (raw)
Related papers
Introduction: Laparoscopic cholecystectomy is associated with an appreciably high rate of postoperative nausea & vomiting (PONV) which is considered as a reason of patient's delay in discharge and disability aggravation. This study was designed to compare the effectiveness of Ondansetron, Dexamethason and Ondansetron plus Dexamethasone as an antiemetic prophylaxis for preventing PONV in patients after laparoscopic cholecystectomy. Methods: In this randomised double blind study, 153 patients of both sexes of ASA I and II aged between 16 to 60 yrs received 4 mg Ondansetron (Group O, n = 50), 8 mg Dexamethason (Group D, n =51) or Ondansetron 4 mg plus Dexamethasone 8 mg (Group OD, n=52) intravenously immediately before induction of anaesthesia. Perioperative care was standardised in all patients. Patient was then observed for 24 hours postoperatively for any episode of PONV and any adverse effects of the study drugs. Results: A complete response (defined as no PONV and no need for another antiemetic) was achieved in 62% of the patients receiving Ondansetron, 64.7% of the patient receiving Dexamethasone and in 84.6% of patients receiving Ondansetron plus Dexamethasone (P<0.05). The overall cumulative incidences (0-24 hrs) of PONV were 40% in Ondansetron group, 37.3% in the Dexamethasone group and 15.4% in combination group (P<0.05). No difference in adverse events was observed in between group. Conclusion: We concluded that combination of Ondansetron plus Dexamethasone is better than each drug alone as an antiemetic prophylaxis against PONV following laparoscopic cholecystectomy.
International journal of scientific research, 2019
INTRODUCTION: Laparoscopic Cholesystectomy is removal of Gall Bladder through abdominal ports which is appreciably associated with postoperative nausea & vomiting (PONV) resulting in increased morbidity and discomforts after the surgery in quite a number of patients. Our study was aimed to compare the efficacy of Ondansetron plus Dexamethasone and only Ondansetron as an antiemetic 30 minutes prior to elective laparoscopic Cholecystectomy. METHODS: In this randomised double blind study, 80 patients of both sexes of ASA I and II aged between 16 to 60 yrs received 4 mg Ondansetron (Group C, n = 40), Ondansetron 4 mg plus Dexamethasone 8 mg (Group T, n=40) intravenously half an hour before induction of general anaesthesia. Peri operative care was standardised in all patients. Patient was then observed for 24 hours postoperatively for any episode of PONV and any adverse effects of the study drugs. RESULTS: A complete response (defined as no PONV and no need for another antiemetic) was achieved in 62% of the patients receiving Ondansetron only and 85% of patients receiving Ondansetron plus Dexamethasone (P<0.05). The overall cumulative incidences (0-24 hrs) of PONV were 64% in Ondansetron only group, 36% in combination group (P<0.05). No difference in adverse events was observed in between group. CONCLUSION: We concluded that combination of Ondansetron plus Dexamethasone is better than Ondansetron alone as an antiemetic prophylaxis for PONV following laparoscopic cholecystectomy.
Surgical Endoscopy, 2008
Background Laparoscopic cholecystectomies are associated with an appreciably high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the effectiveness of ondansetron, granisetron, and dexamethasone for the prevention of PONV in patients after laparoscopic cholecystectomy. Methods A total of 80 American Society of Anesthesiologists (ASA) physical class I-II patients scheduled for laparoscopic cholecystectomy were included in this randomized, double blind, placebo-controlled study. All patients received a similar standardized anesthesia and operative treatment. Patients were randomly divided into four groups (n = 20 each). Group 1, consisting of control patients, received 0.9% NaCl; group 2 patients received ondansetron 4 mg i.v.; group 3 patients received granisetron 3 mg i.v.; and group 4 patients received dexamethasone 8 mg i.v., all before the induction of anesthesia. Both nausea and vomiting were assessed during the first 24 h after the procedure. Results The total incidence of PONV was 75% with placebo, 35% with ondansetron, 30% with granisetron, and 25% with dexamethasone. The incidence of PONV was significantly less frequent in groups receiving antiemetics (p \ 0.05). The differences between dexamethasone, granisetron, and ondansetron were not significant. Conclusions Prophylactic dexamethasone 8 mg i.v. significantly reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy. Dexamethasone 8 mg was as effective as ondansetron 4 mg and granisetron 3 mg, and it was more effective than placebo.
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.
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.
Surgical Endoscopy and Other Interventional Techniques, 2010
Background Patients undergoing general anesthesia for laparoscopic cholecystectomy are at high risk for postoperative nausea and vomiting (PONV). This study compared ramosetron and ondansetron in terms of efficacy for PONV prevention after laparoscopic cholecystectomy. Methods For this study, 120 patients scheduled to undergo laparoscopic cholecystectomy were randomized (in double-blind fashion) to receive 4 mg of ondansetron (group O4, n = 40), 8 mg of ondansetron (group O8, n = 40), or 0.3 mg of ramosetron (group R, n = 40) intravenously after surgery. Postoperative nausea, retching, vomiting, pain, and side effects were assessed at 2 h, 24 h, and 48 h after surgery. Results No statistical differences were observed among the three groups with regard to patient characteristics and information on surgery and anesthesia. The ratio of complete response (no PONV for 2 h) was higher for groups O8 and R than for group O4 as follows: 80% (n = 32) for groups O8 and R versus 58% (n = 23) for group O4 during the first postoperative 2 h (p = 0.04), 90% (n = 36) for groups O8 and R versus 76% (n = 30) for group O4 over 24 h (2–24 h) (p = 0.09), and 98% (n = 38) for groups O4 and O8 versus 100% (n = 40) for group R over the next 24 h (24–48 h) after surgery (p = 0.36). During the first 2 h after surgery, rescue antiemetics were used for significantly fewer patients in groups O8 and R (20%) than in group O4 (42.5%) (p = 0.04). Postoperative pain and the use of rescue analgesics were comparable among the groups. There was no clinically serious adverse event due to the study drugs. Conclusion Ramosetron 0.3 mg and ondansetron 8 mg are more effective than ondansetron 4 mg for the prevention of PONV (2 h). Ramosetron 0.3 mg is as effective as ondansetron 8 mg for the prophylaxis of PONV after laparoscopic cholecystectomy.
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.
Journal of Clinical Anesthesia, 2017
Study objective: To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. Design: Prospective, randomized, double-blind trial. Setting: Operating rooms in a tertiary care hospital of Northern India. Patients: One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. Interventions: Patients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250 ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100 ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. Measurements: Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Main results: Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24 h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). Conclusions: Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly.
Objective: Postoperative nausea and vomiting (PONV) is the most common postoperative complication among patients undergoing laparoscopic procedures, because of the formation of pneumoperitonium during laparoscopic procedures. A number of antiemetic drugs have been used to prevent PONV after laparoscopic cholecystectomy. In this study, we evaluated the safety and efficacy of ondansetron, cyclizine and prochlorperazine in preventing PONV in patients undergoing laparoscopic cholecystectomy (LC). Methodology: In this randomized single blinded controlled trial, we included 195 patients who underwent elective laparoscopic cholecystectomy having ASA status I or II. Selected patients were randomly divided into three equal groups of participants: Group O patients were given ondansetron (4 mg) for the prevention of PONV, Group C patients received cyclizine (50 mg), and Group P patients were given prochlorperazine (10 mg). All groups received their PONV drugs in identical 50 ml syringes. General anesthesia was given to all patients. Metoclopramide was used as a rescue antiemetic drug in all patients. Incidence of PONV within 24 hours, need of rescue anti-emetics and adverse effects e.g. headache, dizziness and sedation within 6 hours after surgery were the focused study outcomes. Comparative analysis was done by Chi-square test or Fischer's exact test as needed. ANOVA test was used to compare quantitative variables between the three groups. P < 0.05 was considered to be significant. Results: There was no significant difference in age, gender, ASA status, and BMI of study participants between three groups. The incidence of nausea was 5 (7.7%) in ondansetron group, 3 (4.6%) in cyclizine group and 5 (7.7%) in prochlorperazine group of patients. Vomiting occurred in 6 patients (9.2%) in Group O, 7 patients (10.8%) in Group C and 3 patients (4.6%) in Group P (p-value 0.67). Rescue anti-emetics were required in 5 patients (7.7%) in Group P, in 4 patients (6.2%) in Group C and in 7 patients (10.8%) in Group O (p-value 0.72). The number of adverse effects, such as headache, dizziness and sedation, were high in Group P as compared to the Group C and Group O but this difference was statistically insignificant (p-value 0.79, 0.63 & 0.91 respectively). Conclusion: Ondansetron, cyclizine and prochlorperazine are equally effective in reducing the incidence of PONV after laparoscopic cholecystectomy with acceptable safety profile. ABSTRACT Citation: Malak AM, Shameem A, Ali CA, Qureshi MA. Comparison of ondansetron, cyclizine and prochlorperazine for PONV prophylaxis in laparoscopic cholecystectomy.
Asian Journal of Pharmaceutical and Clinical Research, 2018
Objectives: Post-operative nausea and vomiting (PONV) is a frequently experienced complication following laparoscopic cholecystectomy. This study was planned to compare the antiemetic efficacy of palonosetron with ondansetron in patients undergoing laparoscopic cholecystectomy. Methods: A total of 100 patients undergoing laparoscopic cholecystectomy were randomized into two groups. Group O (n=50) received ondansetron (8 mg) and Group P (n=50) received palonosetron (0.075 mg) 3 min before induction of anesthesia. Post-operatively, patients were assessed for the occurrence of nausea, retching, or vomiting at 0-2, 2-6, 6-24, 0-24, and 24-48 h time intervals. The overall incidence of PONV in time frame (0-48 h) was determined. The need of rescue antiemetic, side effect profile, and patient satisfaction scores were also assessed. Results: The incidence and severity of nausea at all the time intervals were comparable in the two groups. The incidence of vomiting was significantly less in Group P as compared to Group O in 0-2 h (2% vs. 14%, p=0.027) and 0-24 h time intervals (10% vs. 30%, p=0.012). The overall incidence of PONV in 0-48h was lesser in Group P as compared to Group O (28% vs. 50%, p=0.024). Rescue antiemetic was required in greater number of patients in Group O as compared to Group P (p=0.038). Side effect profile and patient satisfaction scores were comparable in the two groups. Conclusion: Palonosetron is better than ondansetron in lowering the overall incidence of PONV in 0-48 h time interval, in patients undergoing laparoscopic cholecystectomy.