Comparison of Dexamethasone and Ondansetron for the prophylaxis of post operative Nausea and Vomiting in Laparoscopic Gynaecological procedures

Abstract

Introduction: Post-operative nausea and vomiting (PONV) is one of the important complications after laparoscopic surgery resulting in patient dissatisfaction and consumption of healthcare resources. Objectives: We compared the efficacy of dexamethasone and ondansetron in preventing post operative nausea and vomiting in gynaecological laparoscopic surgeries. Methods: After approval from ethical committee and informed consent, the patients were randomly assigned to receive dexamethasone 8 mg or ondansetron 4 mg i.v. at induction. Postoperative PONV scores, pain scores, morphine consumption and Richmond Agitation sedation scores were compared one hourly for 6 hours and at 12 and 24 hours. Results: Both patient groups were similar in age, weight, height, duration of surgery and ASA distribution. No difference  was  observed in PONV scores at 1 hour (p=0.33), 2-3 hours (p=0.27), 4-6 hours (p=0.13) and 7-12 hours (test p=0.48); first episode of vomiting (4.87 sd ±2.29 vs. 4.29 sd ±1.32 hours, p=0.59); maximum pain scores at 1 hour (p=0.61), between 2-3 hours (p=0.32), 4-6 (p=0.47), 7-12 (p=0.57) and 13-24 hours (p=0.79); and post-operative Richmond Agitation Sedation scores (p =0.33; 0.48, and 0.50 at 1-3, 4-6, and 7-12 hours). Mean morphine consumption was similar in two groups at 1-3 hours (2.44 ± 2.18 vs. 3.0 ± 2.0 mg; p=0.24), 4-6 (3.73 ± 2.85 vs. 4.41 ± 2.72 mg; p=0.31), 7-12 (3.81 ± 2.91 vs. 4.75 ± 2.96 mg; p=0.18) and 13-24 hours intervals (3.94 ± 2.97 vs. 4.80 ± 2.97 mg; p=0.23). The time to first occurrence of nausea was significantly delayed in dexamethasone group, (3.85 ± 2.24 vs. 2.25 ± 1.38 hours; p=0.02). Conclusion: The efficacy of dexamethasone and ondansetron in preventing post-operative nausea and vomiting in gynaecological laparoscopic procedures is comparable; onset of nausea is significantly delayed in dexamethasone group.