Granisetron versus Granisetron-Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Randomized Double-Blind Trial

Abstract

Aim. Efficacy of granisetron and combination of granisetron and dexamethasone was evaluated for prevention of postoperative nausea and vomiting (PONV) in children undergoing elective strabismus surgery. Methods. A total of 136 children (1–15 years) were included. Children received either granisetron (40 mcg/kg) [group G] or combination of granisetron (40 mcg/kg) and dexamethasone (150 mcg/kg) [group GD]. Intraoperative fentanyl requirement and incidence and severity of oculocardiac reflex were assessed. PONV severity was assessed for first 24 hours and if score was >2, it was treated with metoclopramide. Postoperative analgesia was administered with intravenous fentanyl and ibuprofen. Results. The demographic profile, muscles operated, and fentanyl requirement were comparable. Complete response to PONV in first 24 hours was observed in 75% (51/68) of children in group G and 76.9% (50/65) of children in group GD, which was comparable statistically (p = 0.96, Fisher exact test; OR 1.11, 95% CI 0.50, 2.46). Incidence of PONV between 0 and 24 hours was comparable. One child in group G required rescue antiemetic in first 24 hours and none of the children had severe PONV in group GD. There was no significant difference in incidence or severity of oculocardiac reflex. Conclusion. Dexamethasone did not increase efficacy of granisetron for prevention of PONV in elective pediatric strabismus surgery. Registration number of clinical trial was CTRI/2009/091/001000.

Comparative study of ondansetron, granisetron and granisetron with dexamethasone for prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy

“…Episodes of nausea, retching, and vomiting were recorded for 0-2, 2-6 and 6-24 h, respectively of the postoperative period in all the three groups and categorized into 4 scores-score 0, score 1, score 2, score 3. 5,14,15 All the three groups were comparable in terms of age with a p value of 0.71 which is not significant. We noticed that there was a preponderance of females undergoing laparoscopic cholecystectomy in all three groups though there was no statically significant intergroup difference in terms of gender.…”

Prospective evaluation of anesthetic protocols during pediatric ophthalmic surgery

“…PONV is a very frequent complication of strabismus surgery without specific preventive medication (65%–90%), though it can be reduced by dexamethasone or Setron (ondansetron or granisetron) systematic administration (22%–37%). 30–32 The dual therapy dexamethasone and Setron reduces its incidence (5%–16%), though not always significantly in comparison with monotherapy. 30–32 Cok et al 35 demonstrated also the utility of paracetamol associated with dexamethasone in the prevention of PONV.…”

“…Our PONV rate after strabismus surgery was 9.6%, while the conversion from ambulatory to conventional hospitalization in the case of PONV rate was 20%. According to the PONV rate without prevention (65%–90%), 30–32 we could hypothesize that we prevented 28–41 cases of PONV (52 strabismus surgeries) and five to eight unexpected conventional hospitalizations. PONV leads to ondansetron and sometimes droperidol (vial: 0.56€ (US$0.66)) curative administrations and the additional cost of a single conversion from ambulatory to conventional hospitalization is 143€ (US$168.9).…”

Granisetron vs. Granisetron and Dexamethasone on The Reduction of Postoperative Nausea and Vomiting (PONV) After Caesarean Section With Intrathecal Morphine: A Randomised Controlled Trial

“…Sample size was calculated based our assumption that the combination of a serotonin receptor antagonist with a corticosteroid would be superior than its monotherapy and thus, the addition of IV dexamethasone to granisetron would reduce the incidence of PONV from 20% to 3.3% [12,13]. Calculation was made using the PS software implementing a dichotomous, independent, prospective, 2 proportions testing to compare prevalence with significance level, = 0.05 and power of 80%.…”