Abstract
Purpose
The combination of antiemetic drugs could be a solution to prevent severe postoperative nausea and vomiting (PONV). The aim of this randomized double blind, dose-ranging study was to determine the minimum single effective dose of dexamethasone combined with ondansetron for the prevention of PONV in patients undergoing laparoscopic cholecystectomy.
Methods
One hundred eighty patients were allocated randomly to one of six groups to receive saline (P group), ondansetron 4 mg (O group), or ondansetron 4 mg and dexamethasone at doses of 2 mg (OD2 group), 4 mg (OD4 group), 8 mg (OD8 group), and 16 mg (OD16 group). A standardized general anesthetic was used. All episodes of PONV during the intervals of zero to six hours, 6–12 hr and 12–24 hr after surgery were evaluated using a numeric scoring system. Mean visual analogue scale pain scores at rest and on movement, the time to first demand of analgesia, total analgesic consumption in 12 hr epochs, duration of hospital stay, and side effects were recorded.
Results
The incidence of PONV in the OD8 (16%) and OD 16 (16%) groups was lower than in the P 83% (P < 0.001) and O groups (50%) at the 12–24 hr epoch (P < 0.05). There were no differences in antiemetic effect between the O, OD2 and OD4 groups and between the OD8 and OD 16 groups. Pain scores, total analgesic consumption, duration of hospital stay and side effects were similar among groups.
Conclusion
Our results suggest that 8 mg is the minimum dose of dexamethasone that, combined with ondansetron 4 mg will effectively prevent PONV in patients undergoing laparoscopic cholecystectomy.
Résumé
Objectif
La combinaison de médicaments antiémétiques pourrait être ia solution de ia prévention des nausées et vomissements postopératoires sévères (NVPO). Le but de notre étude de dosage randomisée et à double insu était de déterminer la dose minimale efficace unique de dexaméthasone qui, combinée à l’ondansétron, puisse prévenir les NVPO chez des patients qui subissent une cholécystectomie laparoscopique.
Méthode
Cent quatrevingt patients ont été répartis au hasard en six groupes et ont reçu une solution saline (groupe P), 4 mg d’ondansétron (groupe O) ou 4 mg d’ondansétron et de la dexaméthasone en doses de 2 mg (groupe OD2), 4 mg (groupe OD4), 8 mg (groupe OD8) ou 16 mg (groupe OD16). Une anesthésie générale normalisée a été utilisée. Tous les épisodes de NVPO survenus entre zéro et six heures, 6–12 h et 12–24 h après l’opération ont été évalués au moyen d’un système de cotation numérique. Les scores de douleur ont été enregistrés avec l’échelle visuelle analogique au repos et lors de mouvement, de même que le moment de la première demande d’analgésie, la consommation totale d’analgésique pour la période de 12 h, la durée du séjour hospitalier et les effets secondaires.
Résultats
L’incidence de NVPO dans les groupes OD8 (16 %) et OD 16 (16%) a été plus faible que dans les groupes P (83 %, P < 0,001) et O (50 %) pendant la période de 12–24 h (P < 0,05). L’effet antiémétique n’a pas présenté de différence entre les groupes O, OD2 et OD4 et entre les groupes OD8 et OD16. Les scores de douleur, la consommation totale d’analgésique, la durée du séjour hospitalier et les effets secondaires ont été similaires d’un groupe à l’autre.
Conclusion
Nos résultats permettent de dire que 8 mg constituent la dose minimale de dexaméthasone qui, combinée à 4 mg d’ondansétron, pourra efficacement prévenir les NVPO chez des patients qui subissent une cholécystectomie laparoscopique.
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Elhakim, M., Nafie, M., Mahmoud, K. et al. Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anesth 49, 922–926 (2002). https://doi.org/10.1007/BF03016875
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DOI: https://doi.org/10.1007/BF03016875