The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl‐based intravenous patient‐controlled analgesia*

Abstract

SummaryWe investigated whether combined dexamethasone and ondansetron is more effective than ondansetron alone in preventing postoperative nausea and vomiting in patients with fentanyl-based intravenous patient-controlled analgesia. One hundred and thirty patients undergoing videoassisted thoracoscopic surgery were assigned to either an ondansetron group or a dexamethasone and ondansetron group. In all patients, ondansetron 4 mg was administered at the end of surgery and 12 mg was added to the patient-controlled analgesia solution. The dexamethasone and ondansetron group received dexamethasone 8 mg at the induction of anaesthesia. The overall incidence of nausea and vomiting during the first 48 h postoperatively did not differ between groups (34/61 (56%) vs 28/62 (45%) in the ondansetron group and dexamethasone and ondansetron groups, respectively). The incidence of severe nausea and vomiting ( ‡ 7 nausea on an 11-point verbal numerical rating scale, retching or vomiting) was higher in the ondansetron group than in the dexamethasone and ondansetron group (15/61 (25%) vs 6/62 (10%, respectively, p = 0.028). Combined dexamethasone and ondansetron is more effective in reducing severe nausea and vomiting than ondansetron alone in patients receiving fentanyl-based intravenous patient-controlled analgesia. Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after surgery. The incidence of PONV varies from 10% to 78% according to surgical, anaesthetic and patient factors [1,2]. Intravenous patient-controlled analgesia (PCA) with opioids is an effective, safe method of postoperative analgesia. Video-assisted thoracoscopic surgery is associated with less postoperative pain than thoracotomy [3], and PCA with fentanyl is an alternative to invasive regional analgesia such as epidural or paravertebral block [4]. However, to be safe and acceptable, PCA in patients undergoing video-assisted thoracoscopic surgery should be accompanied by effective prophylaxis of nausea and vomiting.While several investigators have reported that prophylactic administration of ondansetron reduces PONV in patients using morphine-based PCA [5,6], the incidence of PONV incidence in patients using

Ramosetron, dexamethasone, and their combination for the prevention of postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy

“…Neither postoperative pain nor the amounts of rescue analgesics used differed among the groups in this study. Although several clinical trials have shown that a single perioperative use of dexamethasone 8 mg significantly reduced postoperative pain scores and analgesic requirements in patients who underwent LC [21,22], we did not observe an analgesic effect with dexamethasone alone compared to ramosetron alone [13,23]. A single dose of dexamethasone administered perioperatively is rarely associated with significant side effects such as increased risk of infection, glucose intolerance, delayed wound healing, and adrenal suppression [24].…”

Predictive Factors for Nausea or Vomiting in Patients with Cancer Who Receive Oral Oxycodone for the First Time: Is Prophylactic Medication for Prevention of Opioid-Induced Nausea or Vomiting Necessary?

“…A previous study clarified the effectiveness of steroids for prevention of opioid-induced nausea. 19,20 Treatment with steroids often results in increased appetite, reduced nausea and improved well-being in patients with advanced metastatic cancer. 21 It might also be better to use steroid as prophylactic medication for prevention of opioid-induced nausea for patients with risk factors.…”

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

“…As an antiemetic agent, it has been used at a dose ranging between 2.5-10 mg/day 19,20 . Since nausea and vomiting can occur by a variety of different mechanisms, combinations of different antiemetics are used to prevent or treat these symptoms 6,21 . By the help of these combinations, multiple routes that can lead to nausea and vomiting can be blocked 22 .…”