POSTOPERATIVE NAUSEA AND VOMITING (PONV)

PREOPERATIVE DEXAMETHASONE IN LAPAROSCOPIC CHOLECYSTECTOMY PATIENTS

Abstract

Objective: To evaluate the effect of preoperative single dose injection dexamethasone for prevention of PONV in patients undergoing laparoscopic cholecystectomy and comparing it with normal saline (placebo). Design: Experimental RCT study. Place and duration of study: The study was conducted at Madina Teaching hospital, University Medical & Dental College, Faisalabad from January, 2008 to October 2009. Materials and Methods: After approval from the hospital ethical committee, 200 patients with ASA I & II were included in the study. We divided the patients into two groups; group I received preoperative dexamethasone (8mg) and the group II received normal saline (placebo) 90 minutes before the surgery. Patients were observed for any episodes of nausea or vomiting, need for rescue antiemetics, and complete responses in the postoperative period. The complete response was defined as no nausea, no vomiting, and no ant emetic medication
during a 24-h postoperative period. This was also the primary efficacy end point of the study. The data was analyzed using Pearson’s Chi square test with P < 0.05 taken as significant. Results: Nineteen patients (19%) in the dexamethasone group reported nausea, compared with 43 (43%) in placebo group (p<0.05). Eight patients (8%) in the dexamethasone group reported vomiting and twenty two patients (22%) in the
placebo group reported vomiting (P <0.05). In group I, thirteen patients (13%) asked for rescue anti-emetic where as in group II (placebo group) thirty six patients (36%) asked for rescue anti-emetic (p<0.05). Seventy three patients (73%) in the dexamethasone group showed a complete response, compared with 35 (35%) in placebo group (p<0.05). Conclusion: We concluded that preoperative dexamethasone (8mg) reduces
the incidence of PONV as compared to placebo. As it is a cheap, freely available drug causing no complications, it should be used in otherwise fit selected patients undergoing laparoscopic cholecystctomy.