Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy

Elhakim, M.; Nafie, M M H; Mahmoud, K. S.; Atef, Azza A.

doi:10.1007/bf03016875

Cited by 104 publications

(118 citation statements)

References 25 publications

(21 reference statements)

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“…Our results were in confirmation with the results of the studies conducted by Rajeeva et al 1999 18 , Biswas et al 2003 19 and Elhakim et al 2002 20 .…”

Section: Discussionsupporting

confidence: 93%

Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

Ajani¹,

Singam²,

Chaudhari³

et al. 2013

Int J of Biomed & Adv Res

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Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV).

Methods: This double blind, randomized, prospective, Placebo controlled study was carried out in 120 patients, aged 20-60 yr, ASA-I and II physical status posted for exploratory laparotomy for various clinical conditions under general anaesthesia The patients were divided into three groups of 40 each.

Patients received one of the three regimes for prevention of PONV before induction.

Group P : Received 4 ml Normal saline I.V,

Group O : Received injection Ondansetron 4mg (2 ml) + 2 ml Normal Saline.

Group OD : Received injection Ondansetron 4 mg (2 ml) and injection Dexamethasone 8mg( 2 ml).

Nausea and vomiting were looked from 0 min upto 24 hours. Retching and vomiting were grouped together under common term ' emetic episodes '.

Results: Though ondansetron was effective in controlling postoperative nausea, the ondansetron plus dexamethasone combination was more effective overall. Though ondansetron was effective in reducing postoperative emetic episodes, the combination of ondansetron plus dexamethasone was more effective.The requirement for rescue antiemetic was less in ondansetron group and least in ondansetron plus dexamethasone group. There was no significant difference between pain intensity and sedation between these groups at any time. Only adverse effect reported was headache in ondansetron and ondansetron plus dexamethasone groups.

Conclusion: Ondansetron plus dexamethasone combination is more effective in reducing incidence of PONV without causing any major side effects. Throughout the study, ondansetron plus dexamethasone combination was superior to ondansetron alone in all respects pointing towards the potentiating effect of dexamethasone.

Keywords : PONV, Ondansetron, Dexamethasone, General Anesthesia.

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“…Our results were in confirmation with the results of the studies conducted by Rajeeva et al 1999 18 , Biswas et al 2003 19 and Elhakim et al 2002 20 .…”

Section: Discussionsupporting

confidence: 93%

Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

Ajani¹,

Singam²,

Chaudhari³

et al. 2013

Int J of Biomed & Adv Res

View full text Add to dashboard Cite

Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV).

Patients received one of the three regimes for prevention of PONV before induction.

Group P : Received 4 ml Normal saline I.V,

Group O : Received injection Ondansetron 4mg (2 ml) + 2 ml Normal Saline.

Group OD : Received injection Ondansetron 4 mg (2 ml) and injection Dexamethasone 8mg( 2 ml).

Nausea and vomiting were looked from 0 min upto 24 hours. Retching and vomiting were grouped together under common term ' emetic episodes '.

Keywords : PONV, Ondansetron, Dexamethasone, General Anesthesia.

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“…anaesthesia (20), liberal fluid administration (13,21) and prophylactic antiemetic therapy including serotonergic receptor antagonists (22)(23)(24), dexamethasone (12,25) or combination therapies (4,(26)(27)(28). This is supported by our current anaesthetic regimen, in which moderate PONV was seen in 11% and severe PONV in 2%.…”

Section: Ponvmentioning

confidence: 83%

Post‐operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime

Jensen

Kehlet

Lund

2007

Acta Anaesthesiol Scand

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Background: Laparoscopic cholecystectomy is now often an ambulatory procedure, but dependent on short-term postoperative complaints of pain and post-operative nausea and vomiting (PONV). The efficacy of post-anaesthesia care units (PACUs) is therefore important to facilitate return to normal functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase. Methods: One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre University Hospital between 15 March and 30 September 2005 were included in the study. The standardized, evidence-based regime consisted of total intravenous (i.v.) anaesthesia (propofolremifentanil), well-defined fluid therapy, dexamethasone, ketorolac, ondansetron, sufentanil and incisional bupivacaine intraoperatively, and in the PACU on demand (prn) administration of sufentanil, morphine, paracetamol, ondansetron, droperidol, oral fluids and oxygen (if SpO 2 < 93%) with PACU discharge using a modified Aldrete score. Results: Protocol violations were moderate and occurred unsystematically, 8% had medical violations and 10% did not receive the pre-planned fluid amount. Severe PONV was seen in 2%.

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“…Elhakim M et al concluded that dexamethasone 8mg represented the minimal effective dose for combination with ondansetron 4mg for prophylaxis of PONV. 3 Hence our dose selection is justified.…”

Section: Discussionmentioning

confidence: 97%

“…1,2 various studies have shown that double and triple combinations of antiemetics are effective in prophylaxis of PONV in high risk patients. 3 Granisetron and Ondansetron are commonly used 5HT3 antagonists and used in combination with dexamethasone for prophylaxis against PONV. Ondansetron is commonly used in prophylaxis and treatment of PONV.…”

mentioning

confidence: 99%

A comparative study of ondansetron and granisetron in combination with dexamethasone-in prophylaxis for postoperative nausea and vomiting (PONV) in laproscopic cholecystectomies

Nanjundaswamy

Sridhara

2018

Int J Res Med Sci

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INTRODUCTIONPost operative nausea and vomiting (PONV) is the most common and distressing symptom experienced by surgical patients. The incidence of PONV is 20-30 % in general anaesthesia.1,2 The incidence of PONV is 70-80% in females, and more in ocular, middle ear, gynecological surgeries and laproscopic procedures.2 Without antiemetic prophylaxis, the incidence 50-70% in laproscopic cholecystectomies. PONV causes harm to surgical site sutures, anastomoses.3 It increases intraocular, intra-cranial pressure and may also cause tachycardia, electrolyte imbalance, wound dehiscence, oesophageal tears and aspiration pneumonitis. ABSTRACTBackground: Post operative nausea and vomiting (PONV) is a common problem and distressing symptom in surgical patient population. General anaesthesia with inhalational agents is associated with an average PONV incidence of 20-30 % in surgical patients. PONV is difficult to treat and needs multiple drugs and combination of drugs. Granisetron and Ondansetron are among the commonly used 5HT3 antagonists and used in combination with dexamethasone for prophylaxis against PONV. The aim of the study was to compare the efficacy of combination of antiemeticsOndansetron 4mg+Dexamethasone 8mg and Granisetron 1mg+Dexamethasone 8mg in prevention of post operative nausea and vomiting. Methods: 75 patients of ASA 1 and 2 were randomly allocated to three groups-Group 1 (n=25) received Ondansetron 4mg+Dexamethasone 8mg; Group 2 (n=25)-received Granisetron 1mg+Dexamethasone 8mg; Group 3-received saline with dexamethasone 8mg. Standard general anaesthesia protocol was followed. Study drugs were administered at the time of induction. Post operative nausea and vomiting was studied for period of 24hrs. Severity was assessed using PONV Score (0=no nausea;1=nausea only;2=retching;3=vomiting). The adverse effects were also studied. Results: The incidence of PONV was 16% in Group 1 and 2 and 68% in Group 3. The complete response after 24hr period was 32% in control group, 84% in Group 1 and Group 2. Rescue antiemetics were required only in control group. There was no statistical difference noted between Group 1 and Group 2 but there was clinical and statistical significance noted between groups which received prophylactic antiemetic combination and control. Adverse effects were not observed in any group. Conclusions: Granisetron 1mg and Ondansetron 4mg in combination with dexamethasone 8mg are equally effective and safe in decreasing the incidence of post operative nausea and vomiting in laproscopic cholecystectomies under general anaesthesia.

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Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy

Cited by 104 publications

References 25 publications

Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery

Post‐operative recovery profile after laparoscopic cholecystectomy: a prospective, observational study of a multimodal anaesthetic regime

A comparative study of ondansetron and granisetron in combination with dexamethasone-in prophylaxis for postoperative nausea and vomiting (PONV) in laproscopic cholecystectomies

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