Minimum effective dose of dexamethasone in combination with midazolam as prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy

Abstract

Background:Postoperative nausea and vomiting (PONV) affects 20% and 30% of patients. As many as 60%–80% patients at high risk may be affected. Dexamethasone (D) and midazolam (M) are well studied as antiemetic. Use of D can be associated with certain undesirable side effects so minimum dose is preferred. M is a routinely used premedicant. Hence, this study was designed with both D and M in high risk patients for PONV to find minimum effective dose of D.Aims:To determine the minimum dose of D that combined with M would provide effective prophylaxis of PONV after laparoscopic cholecystectomy (LC) in patients at high risk for PONV.Setting and Design:This is a prospective, randomized double-blind trial.Materials and Methods:One hundred and fifty-five patients scheduled for elective LC were randomized to 5 groups of 31 each. Group C was given normal saline, and the rest were administered D 1 mg (group MD1), 2 mg (group MD2), 4 mg (group MD4), or 8 mg (group MD8) in combination with 0.04 mg/kg M at induction. The incidence of nausea, vomiting, severity of nausea, and the use of rescue antiemetic and postoperative pain was analyzed.Statistical Analysis:Chi-square test was used to compare incidence of study variables. Independent Student's t-test was used for continuous variables. Demographic data were compared using ANOVA. P < 0.05 was considered statistically significant.Results:The incidence of nausea was significantly lower in group MD4 (29%) and MD8 (6%) compared to placebo group (71%) (P < 0.001) and of vomiting was significantly lower in groups of MD2 (58%), MD4 (48%), and MD8 (6%) compared with placebo (90%) (P < 0.001) at 24 h. There was significant reduction in nausea, pain severity, and incidence of use of rescue antiemetic in MD4 and MD8 groups with no discernable side effects of the drugs.Conclusion:We conclude that 4 mg D with M and 2 mg D with M is effective for prevention of nausea and vomiting, respectively, in patients at high risk for PONV undergoing LC.

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“… 152 found that dexamethasone 4–5 mg was equally as effective as 8–10 mg in terms of antiemetic efficacy. Dexamethasone antiemetic efficacy alone or in combination has been reported in patients undergoing laparoscopic cholecystectomy 153 – 164 , other abdominal laparoscopic procedures 150 , breast cancer surgery 165 , large and small bowel surgery 166 , total knee arthroplasty 167 , joint replacement surgery 168 , gynecological laparoscopic procedures 169 , 170 , cesarean delivery 171 , scoliosis correction surgery 172 , vitrectomy under local anesthesia 173 , and upper extremity surgery 174 as well as in endoscopic adenoidectomy 175 and strabismus correction surgery 176 in children. Interestingly, there are reports that dexamethasone did not reduce PONV in patients undergoing surgery for facial fracture 177 , laparoscopic surgery for suspected appendicitis 178 , and microvascular decompression surgery of the trigeminal nerve root 179 .…”

Effect of Intravenous Oxycodone Versus Sufentanil on the Incidence of Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery

“…To date, numerous studies have been conducted to investigate effective ways to decrease the incidence of PONV . It has been reported that using dexamethasone at the beginning of induction of anesthesia, decreasing the use of opioids or avoiding opioids, using total intravenous anesthesia, avoiding inhaled anesthetics, and prophylaxis with antiemetics are effective ways to decrease PONV . Although decreasing the use of opioids is related to a decreased incidence of PONV, opioids cannot be eliminated because they can provide stable hemodynamics during tracheal intubation and provide indispensable analgesic effects for moderate to severe postoperative pain .…”

Low-dose Dexamethasone in the Prevention of Postoperative Nausea and Vomiting After Total Joint Arthroplasty: a Retrospective Study

“…Backes et al [20] proved that the combined administration of 10 mg dexamethasone and other antiemetic drugs can enhance the antiemetic effect in patients undergoing unilateral total hip or knee replacement. However, there is increasing evidence that lower dose of dexamethasone may also exert antiemetic effects [21,22]. The fourth consensus guidelines for the management of postoperative nausea and vomiting suggested that the recommended dose of dexamethasone range between 4 and 10 mg [13].…”