ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 145-152

Comparison between ondansetron and a combination of low-dose dexamethasone and metoclopramide in the prevention of nausea and vomiting after laparoscopic cholecystectomy


1 Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
2 Department of Anesthesia and Intensive Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Hassan M. Aref
B.Sc, Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.ASJA.0000428276.33180.39

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Background

Laparoscopic cholecystectomy is associated with a high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the efficacy of a combination of low-dose dexamethasone and metoclopramide with ondansetron for the prevention of nausea and vomiting after laparoscopic cholecystectomy.

Methods

A total of 120 ASA physical status I and II patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were included in this randomized, double-blind, placebo-controlled study. The patients were randomly assigned to one of three groups (n=40): the ondansetron group (GO) comprised patients who received ondansetron (4 mg i.v.) at induction of anesthesia; the dexamethasone–metoclopramide group (GDM) comprised patients who received dexamethasone (2.5 mg i.v.) at induction of anesthesia and metoclopramide (10 mg i.v.) just before recovery; and the placebo group (GP) comprised patients who received the 2 ml of saline which is equal to volume of dexamethasone, ondansetron and metoclopramide injection. All patients underwent similar standardized anesthetic and surgical techniques. Nausea and vomiting were assessed during the first 24 h after surgery using an 11-point verbal numerical rate score, in which 0 indicates no nausea and 10 indicates severe nausea and/or vomiting or retching. The severity of PONV was graded using the same scale according to the degree of nausea or the presence of retching or vomiting as: mild (1–3), moderate (4–6), severe (7–10), and/or presence of retching or vomiting. The blood glucose levels and serum cortisol levels were measured before and after surgery. Adverse effects related to the medications used such as dizziness, constipation, urinary retention, sweating, sleep disturbances, or headaches were recorded.

Results

The total incidence of PONV during the first 24 h after surgery was 30% in GDM compared with 35% in GO (P=0.811) and 72.5% in GP (P=0.003). There was no significant difference between GO or GDM in the incidence of PONV (P=0.811). None of the GDM patients required a rescue antiemetic compared with three patients in GO (P=0.077) and eight in the GP (P=0.003). No significant increase in blood glucose level or decrease in serum cortisol levels was observed in GDM patients.

Conclusion

The combination of low-dose dexamethasone (2.5 mg) and metoclopramide (10 mg) was as effective as ondansetron (4 mg) in the prevention of PONV after laparoscopic cholecystectomy without significant side effects.



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