Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair

Abstract

This study evaluated the antiemetic efficacy, cost-effectiveness and clinical utility of prophylactic ondansetron and dexamethasone compared with placebo in the prevention of postoperative nausea and vomiting (PONV) in 135 children (2-15 yr, ASA I-II) undergoing strabismus repair. After induction with halothane and nitrous oxide in oxygen or i.v. thiopental, the children received i.v. dexamethasone 1 mg kg(-1) to a maximum of 25 mg, ondansetron 100 microg kg(-1) to a maximum of 4 mg or placebo (n=45). Episodes of PONV were recorded for the first 24 h after the operation. True outcome measures (parental satisfaction score, duration of stay in the postanaesthesia care unit and fast tracking time), therapeutic outcome measures (number needed to prevent (NNTP) PONV) and the cost to benefit a child with each drug were analysed. The incidence and severity of PONV in the first 24 h were significantly less in the dexamethasone and ondansetron groups than in the placebo group (P<0.05). The incidence (P=0.04) and severity (P=0.03) of PONV at the 6-24 h epoch were significantly less in the dexamethasone group than in the ondansetron group. Recovery time (P=0.07), fast tracking time (P=0.6), parental satisfaction scores (P=0.08) and NNTP PONV were comparable (NNTP=2) in both the ondansetron and the dexamethasone group. The cost to benefit a child with dexamethasone was approximately 22 times less than that of ondansetron.

Postoperative Nausea and Vomiting in Patients Undergoing Total Abdominal Hysterectomy Under Subarachnoid Block: A Randomized Study of Dexamethasone Prophylaxis

“…13,19 Since a dose of 2.5 or 5 mg were found to be equally effective as 10mg in reducing the incidence of postoperative emesis in patients undergoing major gynaecological surgeries, a dose of 4 mg was chosen in this study. 13 Our study has shown that prophylactic use of 4 mg dexamethasone intravenously 1 hour prior to SAB, in patients undergoing TAH, significantly reduces the incidence of nausea and vomiting and the requirement of antiemetics in the postoperative period.…”

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

“…Dexamethasone is a glucocorticoid that produces a strong antiemetic effect 16,17 by an undetermined mechanism. It may act through prostaglandin antagonism, 18 serotonin inhibition in the gut, 19 and by releasing endorphins.…”

Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

“…Recently, a combination of ondansetron and dexamethasone has been shown to be a highly effective prophylactic measure in patients undergoing laparoscopic cholecystectomy [6]. However, the higher cost of ondansetron has been a significant factor limiting its routine prophylactic use [28]. Therefore, we used metoclopramide, the most common and low-cost antiemetic agent, instead of ondansetron.…”