Gabapentin Versus Dexamethasone for Prophylaxis of Post-Operative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Post-operative nausea and vomiting (PONV) is one of the commonest complications in anaesthesia accounting for 20-30% cases but number may rise to 70% in laparoscopic surgeries.1,2 Laparoscopic cholecystectomy is carried out as day care surgery but PONV prolongs hospital stay. Several studies have documented role of Gabapentin and Dexamethasone for prophylaxis of PONV but none has compared them for the same. This study aimed at comparing the efficacy of oral gabapentin and dexamethasone for prophylaxis of PONV and need for rescue anti-emetics in first 24 hours. Methods: This prospective, single blind randomized trial enrolled 100 ASA physical status I and II patients assigned into two groups: Group G (Gabapentin group, n=50) received 600 mg of Gabapentin oral formulation with sip of water on the morning of surgery whereas Group D (Dexamethasone group, n=50) received 8 mg of Dexamethasone oral formulation with sip of water on the morning of surgery. Following parameters were noted: time to first rescue anti-emetic drug (Injection Ondansetron), total number of rescue anti-emetic doses, complications if any. Results: The two groups i.e the Gabapentin group and the dexamethasone group were comparable with regards to the demographic profile (age, weight and sex). However the mean duration of surgery was more in Gabapentin group compared to Dexamethasone group, the difference being statistically significant (P< 0.05). Time between extubation and first rescue antiemetic was also comparable in the two groups the results being statistically non significant (P > 0.05). The mean of total number of rescue antiemetics in 24 hours as well as grading of Wilsons score for PONV in the two groups was also statistically non significant (P > 0.05). Conclusion: Both the drugs gabapentin and dexamethasone are equally effective in preventing postoperative nausea and vomiting.

Comparison of Ondansetron Used Alone and in Combination with Dexamethasone as a Prophylaxis for Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy.

Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence can be as high as 76% which would cause unexpected delay in hospital discharge. This study was designed to compare the efficacy of the ondansetron alone with combination of ondansetron and dexamethasone the given as prophylaxis for PONV in patients undergoing laparoscopic cholecystectomy. One hundred patients undergoing elective laparoscopic cholecystectomy were selected and randomly divided into 2 groups of 50 each. Group I received 4mg of ondansetron intravenously (iv), whereas Group II received ondansetron 4mg and dexamethasone 4mg just before induction of anaesthesia. Postoperatively, the patients were assessed for episodes of nausea, vomiting and need for rescue antiemetic. Complete response defined as no nausea and vomiting during first 24 hours, was noted in 76% of patients in Group I and in 92% of patients in Group II. Rescue anti emetic requirement was less in Group II (4%) than Group I (20%). So it can be concluded that the combination of ondansetron and dexamethasone is more effective in preventing PONV in patients undergoing laparoscopic cholecystectomy than ondansetron alone.