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Comparison of Dexamethasone–Dimenhydrinate and Dexamethasone–Ondansetron in Prevention of Nausea and Vomiting in Postoperative Patients

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  • Face and Neck Surgery
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Abstract

Introduction

Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone–dimenhydrinate and dexamethasone–ondansetron combinations in prevention of nausea and vomiting in postoperative patients.

Method

Sixty 18–65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone–dimenhydrinate group (group DD) and dexamethasone–ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air–oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated.

Observations

Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups.

Result

Our study revealed that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron in prevention of nausea and vomiting after rhinoplasty operations.

Level of Evidence IV

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References

  1. Camu F, Lauwers MH (1992) Incidence and etiology of postoperative nausea and vomiting. Eur J Anaesthesiol 9:25–31

    Google Scholar 

  2. Gan TJ et al (2014) Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118:85–113

    Article  PubMed  Google Scholar 

  3. Apfel CC, Laara E (1999) A simplified risk skor for predicting postoperative nausea and vomiting. Anesthesiology 91:693–700

    Article  CAS  PubMed  Google Scholar 

  4. Marcus JR, Few JW (2002) The prevention of emesis in plastic surgery: a randomized prospective study. Plast Reconstr Surg 109:2487–2494

    Article  PubMed  Google Scholar 

  5. Watcha MF, White PF (1992) Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology 77:162–184

    Article  CAS  PubMed  Google Scholar 

  6. Steely RL, Collins DR, Cohen BE et al (2004) Postoperative nausea and vomiting in the plastic surgery patient. Aesth Plast Surg 28:29–32

    Article  Google Scholar 

  7. Hill RP, Lubarsky DA (2000) Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol or placebo. Anesthesiology 92:958–967

    Article  CAS  PubMed  Google Scholar 

  8. Lau H, Brooks DC (2001) Predictive factors for unanticipated admissions after ambulatory laparoscopic cholecystectomy. Arch Surg 136:1150–1153

    Article  CAS  PubMed  Google Scholar 

  9. Mehernoor F, Watcha M (2001) Economics of antiemetics in anesthesia. Curr Opin Anaesthesiol 14:563–567

    Article  Google Scholar 

  10. Apfel CC, Kranke P (2002) Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: arandomized controlled trial of factorial design. Br J Anaesth 88:659–668

    Article  CAS  PubMed  Google Scholar 

  11. Kothari SN, Boyd WC (2000) Antiemetic efficacy of prophylactic dimenhydrinate(Dramamine) vs ondansetron (Zofran): a randomized, prospective trial in patients undergoing laparoscopic cholecystectomy. Surg Endosc 14:926–929

    Article  CAS  PubMed  Google Scholar 

  12. Kranke P, Morin AM (2002) Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 46:238–244

    Article  CAS  PubMed  Google Scholar 

  13. Gildasio S, De Oliveira GS (2013) Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg 116:58–74

    Article  Google Scholar 

  14. Borison HL (1989) Area postrema: chemoreceptor circumventricular organ of the medulla oblongata. Prog Neurobiol 32:351–390

    Article  CAS  PubMed  Google Scholar 

  15. Gan TJ (2007) Mechanismus underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy. CNS Drugs 21:813–833

    Article  CAS  PubMed  Google Scholar 

  16. Gan TJ, Meyer TA (2007) Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Society for ambulatory anesthesia. Anesth Analg 105:1615–1628

    Article  PubMed  Google Scholar 

  17. Apfel CC, Korttila K (2004) IMPACT investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 350:2441–2451

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Arslan M, Demir ME (2011) Prevention of postoperative nausea and vomiting with a small dose of propofol combined with dexamethasone 4 mg or dexamethasone 8 mg in patients undergoing middle ear surgery: a prospective randomized duble-blind study. Bratisl Lek Listy 112:332–336

    CAS  PubMed  Google Scholar 

  19. Sistla S, Rajesh R (2009) Does single-dose preoperative dexamethasone minimize stress response and improve recovery after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 19:506–510

    Article  PubMed  Google Scholar 

  20. Fujii Y, Itakura M (2009) Reduction of postoperative nausea, vomiting and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy. Surg Endosc 24:692–696

    Article  PubMed  Google Scholar 

  21. Tolver MA, Strandfelt P (2012) Randomized clinical trial of dexamethasone versus placebo in laparoscopic inguinal hernia repair. Br J Surg 99:1374–1380

    Article  CAS  PubMed  Google Scholar 

  22. Murphy GS, Szokol JW (2011) Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in-hospital and postdischarge recovery outcomes. Anesthesiology 114:882–890

    Article  CAS  PubMed  Google Scholar 

  23. Youssef TA, Elibiary H (2013) Role of steroids in reducing postoperative edema in rhinoplasty: a meta-analytic study. Eur Arch Otorhinolaryngol 270:1189–1193

    Article  PubMed  Google Scholar 

  24. Tramer MR, Reynols DJ (1997) Efficacy dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology 87:1277–1289

    Article  CAS  PubMed  Google Scholar 

  25. Barbosa MVJ, Nahas FX et al (2004) Ondansetron for the prevention of postoperative nausea and vomiting: which is the best dosage for aesthetic plastic surgery? Aesth Plast Surg 28:33–36

    Article  Google Scholar 

  26. Henzi I, Walder B (2000) Dexamethasone for the prevention of postoperative nausea and vomiting. a quantitative systematic review. Anesth Analg 90:186–194

    Article  CAS  PubMed  Google Scholar 

  27. Caroll NV, Miederhoff PA (1994) Costs incurred by outpatient surgical centers in managing postoperative nausea and vomiting. J Clin Anesth 6:364–369

    Article  Google Scholar 

  28. Dexter F, Tinker JH (1995) Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology 82:94–101

    Article  CAS  PubMed  Google Scholar 

  29. Zarate E, Watcha MF (2000) A Comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis. Anesth Analg 90:1352–1358

    Article  CAS  PubMed  Google Scholar 

  30. Watcha MF, Smith I (1994) Cost-effectiveness analysis of antiemetic therapy for ambulatory surgery. J Clin Anesth 6:370–377

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Nurcan Kizilcik.

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Kizilcik, N., Bilgen, S., Menda, F. et al. Comparison of Dexamethasone–Dimenhydrinate and Dexamethasone–Ondansetron in Prevention of Nausea and Vomiting in Postoperative Patients. Aesth Plast Surg 41, 204–210 (2017). https://doi.org/10.1007/s00266-016-0772-0

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