ABSTRACT
Background: Post-operative nausea and vomiting (PONV) is generally self-limiting, associated with high level of patient dissatisfaction and may delay hospital discharge. The anaesthetist is usually blamed, despite evidence that PONV results from a variety of factors and variety of antiemetic drug available in market. With this issue we aim to compare the effectiveness of dexamethasone with granisetron or ondansetron in patients undergoing laparoscopic gynaecological surgery.Methods: 120 patients were registered in this prospective, randomized double blind study. Group I (n=60) received ondansetron 4 mg intravenously (IV)+dexamethasone 8mg I/V or II (n=60) received granisetron 1 mg IV+dexamethasone 8 mg I/V prior to anaesthesia. Post-operative data of PONV was recorded at pre-defined intervals.Results: The majority of the patients were of the age group 20-25 years (55.83%). The mean score of Group I subjects was 0.30±0.72 and that of Group II was 0.20±0.57 (p=0.43). There are 3.33% of patients in group-I having vomiting episodes, and 1.67% of patients in group-II having vomiting episodes, none of the patients developed 2nd episodes of vomiting in either group. Thus it appears that dexamethasone in combination with ondansetron and granisetron is effective in decreasing the number of episodes of PONV. The occurrence of sickness episodes within 24 hours of surgery revealed no significant different in both groups. Haemodynamic variables showed no significant difference recorded in postoperative care unit between the study groups. The most common complaint was headache 16.67% in both groups. Conclusions: Dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg showed no significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.
ABSTRACT
The aim of the study is to compare efficacy of intravenous (i/v) Palonosetron (75mcg), i/v Ondansetron (4mg) and i/v Dexamethasone (5mg) as prophylactic agents for reducing post-operative nausea and vomiting that follows laparoscopic cholecystectomy. Methods: This prospective randomized double blind study was conducted in the Department of Anaesthesia and Critical Care, Tata Main Hospital, Jamshedpur. The study participants comprised of patients undergoing elective laparoscopic cholecystectomy surgeries under general anaesthesia. A total of 90 patients i.e. 30 in each of the three groups were enrolled for the study. Enrolled patients were randomly allocated to received with i/v Dexamethasone (5 mg) or i/v Ondansetron (4mg) or i/v Palonosetron (0.075 mg). The patients in the three groups were monitored and symptoms charted on basis of Post Operative Nausea and Vomiting (PONV) scale. Results: Palonosetron 0.075mg single intravenous dose given prior to induction of anaesthesia achieves 100% complete response with 3.33% reported side effect, and none needed rescue antiemetic. Dexamethasone 5mg single intravenous dose given prior to induction of anaesthesia achieves 93.33 % complete response with none reporting side effect and 6.67% needing rescue antiemetic. Ondansetron 4mg single intravenous dose given prior to reversal of neuromuscular blockade achieves 66.67 % complete response with 20% reporting side effect and 33.33 % needing rescue antiemetic. Conclusion: I.V. Palonosetron and Dexamethasone are equally potent and superior antiemetics than Ondansetron in the prevention of PONV in patients undergoing elective laproscopic cholecystectomy under general anaesthesia.