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Efficacy comparison of ondansetron with dexamethasone in preventing
nausea and vomiting in post laparoscopic surgeries
ABSTRACT
Backgroung: Incidence of post operative nausea and vomiting is high following laparoscopic surgeries. It is
a major cause of morbidity and extended hospital stay. A considerable number of drugs are used for
managing PONV with fewer side effects.
Aim:To compare the effects of intravenous Ondansetron and Dexamethasone to prevent PONV following
laparoscopic surgeries.
Methods: This is a prospective, double blind study comprising 50 patients between 15-50 yrs and ASA grade I
and II scheduled for laparoscopic surgery under general anesthesia. Patients were randomly divided into
Group O ( Ondansetron 4mg iv) and Group D (inj.Dexamethasone 8mg iv). The drug was given half an hour prior
to surgery. All the vital parameters of patients were observed during intraoperative and postoperative period
for next 24 hrs; episodes of nausea, vomiting or retching and any other side effects were evaluated on a 3 -point
ordinal scale.Rescue antiemetic was administered if the patient had 2 or more episodes of emesis.
Results: Incidence of nausea and vomiting as well as rescue drug requirement was higher in group D as
compared to group O.
Conclusion: Efficacy of Ondanseteron was found better than Dexamethasone with lesser side effects.
Keywords: laparoscopic surgery, post-operative nausea and vomiting, PONV, ondansetron, dexamethasone INTRODUCTION
MATERIALS AND METHODS
Post-operative nausea and vomiting (PONV) after This prospective,randomized, double blind study laparoscopic surgeries under general anesthesia was carried out after approval from institutional (G.A) are one of the frequent causes of prolonged ethics committee in 50 patients of age group 15-50 hospital stay in day care surgery. Although it is self- years and ASA physical status of grade I and II limiting however, it can cause significant morbidity scheduled for various elective laparoscopic including dehydration, electrolyte imbalance, procedures under general anesthesia in a tertiary suture tension and wound dehiscence, venous care hospital at Bhavnagar, Gujarat. Patients with hypertension and bleeding,oesophageal rupture history of diabetes mellitus, allergic to local and life threatening airway compromise.
anaesthetics, acid peptic disorders, hepatic Many drugs are used for management of PONV but disorders, and history of PONV or taking antiemetic few of them have side effects like sedation, medication were excluded from the study. dysphoria , extrapyramidal symptoms , dry A f t e r p r e - a n a e s t h e t i c e v a l u a t i o n a n d mouth,restlessness and tachycardia. 5HT3 investigations, the patients were explained about receptors antagonists are devoid of such side the procedure and informed written consent was effects. Ondansetron and Dexamethasone are obtained. Standard pre-operative procedure was commonly used drugsfrom this group to prevent followed and baseline vital parameters were recorded. They were pre-medicated with inj. In our study, we used intravenous Ondansetron Diclofenac 1.5 mg/kg, inj Ranitidine 1mg/kg, inj. 4mg and compared its effect with intravenous Glycopyrrolate 4mcg/kg iv half an hour before Dexamethasone 8mg to prevent PONV following surgery and randomly allocated into two group; elective laparoscopic surgeries under G.A.
Group O and Group D. Inj Ondansetrone 4 mg and Suwalka U et al. Efficacy comparison of ondansetron with dexamethasone in preventing nausea and vomiting in post laparoscopic surgeries IJRRMS 2013;3(1) inj Dexamethasone 8mg iv was administered Table 1.Patient's characteristics and duration of
respectively half an hour prior to surgery. After pre- oxygenation with 100% oxygen, induction was done with inj sodium thiopentone 5 – 7 mg/kg iv and endotracheal intubation was facilitated by using inj. Succinylcholine 2mg/kg. Gastric distention during induction was avoided by using low airway pressure ventilation after the muscle relaxant had begun to take effect. Intubation was done with appropriate sized portex cuffed endotracheal tube. After checking bilateral air entry,patients were placed on controlled Post-operative episode of nausea was observed ventilation. Anaesthesia was maintained with immediately after surgery in 8% of patients in both groups. Episode of nausea in next two hours was with inj. Vecuronium bromide 0.08 mg/kg iv as a 4% in group O and 12% in group D. Between 2- 6 non-depolarising muscle relaxant. Non-invasive hours; it was 8% in group O and 20% in group D. No monitoring continued intraoperative through ECG, episode of nausea was observed in group O after 6 hourswhereas it was 8% between 6 to 12 hours in group D.(Table-2). No episode of vomiting was After completion of surgery the neuromuscular observed in both the groups after 24 hours which blockade was reversed with inj. neostigmine 0.04 – was found statistically significant. Difference in the 0.06mg/kg and inj. glycopyrrolate 8ìg/kg PONV score between two groups was statistically IV.Patients were extubated after recovery of active highly significant (p<0.05) (Table-3).
oropharyngeal reflexes. Vital parameters, duration of surgery and anesthesia were recorded. Patients Table. 2. Distribution of patients experiencing
were observed for next 24 hrs in the recovery room and ward for any episodes of nausea and vomiting or retching which were evaluated on a 3 point o r d i n a l s c a l e . R e s c u e a n t i e m e t i c ( i n j Metoclopramide 10 mg IV) was given if the patient had 2 or more episodes of emesis and was also recorded. All the patients were observed for side effects such as drowsiness, sedation, muscle pain,constipation,diarrhea or extrapyramidal Table.3. PONV score
reaction and treated accordingly upto 24 hrs.
Data were analyzed using unpaired “t” test and p value < 0.05 was considered statistically significant. Data was presented as mean ± standard deviation Rescue antiemetic was given when PONV score age,sex,height and weight were comparable in was 2. Requirement of rescue antiemetic was both the groups (Table-1).There was no statistically minimum, i.e., 8% in group O. Incidence of side significant difference in respect to duration of effects (headache, constipation and dizziness) was surgery and duration of anesthesia in both the less in group O as compared to group D.
Suwalka U et al. Efficacy comparison of ondansetron with dexamethasone in preventing nausea and vomiting in post laparoscopic surgeries IJRRMS 2013;3(1) DISCUSSION
component like incidences of early and late nausea Limited studies have compared the effects of dexamethasone and ondansetron on PONV, and comparable with similar studies Incidence of side their findings are contradictory. A study report that effects was comparable with the study of Henzi I effect of ondansetron is comparable with CONCLUSION
ondansetron was better than dexamathasone and yet another study showed that dexamethasone Prophylactic therapy with ondensatron is more was a little more effective than ondansetron in effective than Dexamethasone for prevention of PONV with least side effect. We advocate, ondensatron may be added routinely as a pre- The difference in the findings of the above studies medication of general anesthesia for laparoscopic might be related to wide range of differences in sample sizes, patients qualities, type of surgical operations and anesthetic techniques, the way AUTHOR NOTE
that PONV was defined and studied, and most U s h a S u w a l k a , P r o f e s s o r, C o n t a c t N o -
important of all the dosage of the antiemetic drugs (Corresponding Author)
The present study showed that ondansetron was Anaesthesiology, SBKS MI & RC, Baroda more effective than dexamethasone in preventing PONV. The results were comparable with a study wherein the demographic profile, types of laparoscopic surgeries, duration of anaesthesia and surgeries were similar with this study. The REFERENCES
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