Surgical Endoscopy

, Volume 21, Issue 4, pp 607–612

Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

  • V. Nesek-Adam
  • E. Grizelj-Stojčić
  • Ž. Rašić
  • Z. Čala
  • V. Mršić
  • A. Smiljanić
Article

Abstract

Background

Postoperative nausea and vomiting (PONV) are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the efficacy of dexamethasone, metoclopramide, and their combination to prevent PONV in patients undergoing laparoscopic cholecystectomy.

Methods

A total of 160 ASA physical status I and II patients were included in this randomized, double blind, placebo-controlled study. Patients were randomly assigned to 4 groups (n = 40 each): group 1 consisting of control patients administered 0.9% NaCl; group 2 patients received metoclopramide 10 mg just before the end of anesthesia; group 3 patients received dexamethasone 8 mg after the induction of anesthesia; and group 4 patients received dexamethasone 8 mg after the induction of anesthesia and metoclopramide 10 mg before the end of anesthesia. The incidence of PONV, mean visual analog pain scores at rest and on movement, time to the first request for analgesia, side effects, and well-being score were recorded during the first 24 h postoperatively.

Results

Data were analyzed using one-way analysis of variance (ANOVA) and the χ2 test, with p < 0.05 considered statistically significant. The total incidence of PONV was 60% with placebo, 45% with metoclopramide, 23% with dexamethasone, and 13% with the combination of dexamethasone plus metoclopramide. None of the dexamethasone plus metoclopramide group patients (p < 0.05 versus groups 1 and 2) and one dexamethasone group patient (p < 0.05 versus group 1) required antiemetic rescue, as compared with four patients in the metoclopramide group and six patients in the placebo group. Pain scores, the time to the first request for analgesia, and side effects were similar across the study groups.

Conclusions

Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV than metoclopramide and placebo.

Keywords

Laparoscopic cholecystectomy Postoperative nausea and vomiting Dexamethasone Metoclopramide 

References

  1. 1.
    Aapro MS, Alberts DS (1981) Dexamethasone as an antiemetic in patients treated with cisplatin. N Engl J Med 305:520PubMedGoogle Scholar
  2. 2.
    Aapro MS, Plezia PM, Alberts DS, Graham V, Jones SE, Surwit EA, Moon TE (1984) Double-blind cross-over study of the antiemetic efficacy of high dose dexamethasone versus high dose metoclopramide. J Clin Oncol 2:466–467PubMedGoogle Scholar
  3. 3.
    Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, Rosenberg J (1999) Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi modal analgesia: a randomized, double blind, placebo-controlled study. Anesth Analg 89:1017–1024PubMedCrossRefGoogle Scholar
  4. 4.
    Biswas BN, Rudra A (2003) Comparison of granisetron and granisetron plus dexamethasone for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 47:79–83PubMedCrossRefGoogle Scholar
  5. 5.
    Domino KB, Anderson EA, Polissar NL, Posner KL (1999) Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 88:1370–1279PubMedCrossRefGoogle Scholar
  6. 6.
    Elhakim M, Nafie M, Mahmoud K, Atef A (2002) Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Can J Anesth 49:922–926PubMedCrossRefGoogle Scholar
  7. 7.
    Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A (1994) Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 79:152–154PubMedGoogle Scholar
  8. 8.
    Fujii Y, Tanaka H, Toyooka H (1997) The effects of dexamethasone on antiemetics in female patients undergoing gynaecologic surgery. Anesth Analg 85:913–917PubMedCrossRefGoogle Scholar
  9. 9.
    Fujii Y, Uemara A, Tanaka H (2002) Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomized controlled trial. Eur J Surg 168:583–586PubMedCrossRefGoogle Scholar
  10. 10.
    Glaser C, Sitzwohl C, Wallner T, Lerche A, Marhofer P, Schindler I (2004) Dixyrazine for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 48:1287–1291PubMedCrossRefGoogle Scholar
  11. 11.
    Harris AL (1982) Cytotoxic-therapy-induced vomiting is mediated via enkephalin pathways. Lancet 1:714–716PubMedCrossRefGoogle Scholar
  12. 12.
    Henzi I, Walder B, Tramer MR (1999) Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo controlled studies. Br J Anaesth 83:761–771PubMedGoogle Scholar
  13. 13.
    Henzi I, Walder B, Tramer MR (2000) Dexamethasone for postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 90:186–194PubMedCrossRefGoogle Scholar
  14. 14.
    Huang JC, Shieh JP, Tang CS, Tzeng JI, Chu KS, Wang JJ (2001) Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery. Can J Anesth 48:973–977PubMedGoogle Scholar
  15. 15.
    Italian Group for Antiemetic Research (1995) Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med 332:1–5CrossRefGoogle Scholar
  16. 16.
    Kenny GN (1992) Risk factor for postoperative nausea and vomiting. Anaesthesia 49:6–10CrossRefGoogle Scholar
  17. 17.
    Kovac AL (2000) Prevention and treatment of postoperative nausea and vomiting. Drugs 59:213–243PubMedCrossRefGoogle Scholar
  18. 18.
    Lopez-Olaondo L, Carrascosa F, Pueyo FJ, Mondero P, Busto N, Saez A (1996) Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth 76:835–840PubMedGoogle Scholar
  19. 19.
    Maddali MM, Mathew J, Fahr J, Zarroung AW (2003) Postoperative nausea and vomiting in diagnostic gynaecological procedure: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron. J Postgrad Med 49:302–306PubMedGoogle Scholar
  20. 20.
    Madsen MR, Jensen KEJ (1992) Postoperative pain and nausea after laparoscopic cholecystectomy. Surg Laparosc Endosc 2:303–305PubMedGoogle Scholar
  21. 21.
    McKenzie R, Tantisira B, Karambelker DJ, Riley TJ, Abdelhady H (1994) Comparison of ondansetron with ondansentron plus dexamethasone in the prevention of postoperative nausea and vomiting. Anaest Analg 79:961–964Google Scholar
  22. 22.
    Naguib M, el Bakry A, Khoshim MH, Channa AB, el Gammal M, el Gammal K, Eihattab YS, Attia M, Jaroudi R, Saddique A (1996) Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 43:226–231PubMedCrossRefGoogle Scholar
  23. 23.
    Nesek Adam V, Grizelj Stojčić E, Mršić V, Smiljanić A, Rašić Ž, Čala Z (2004) Prophylactic antiemetics for laparoscopic cholecystectomy: droperidol, metoclopramide, and droperidol plus metoclopramide. J Laparoendosc Adv Surg 14:212–221Google Scholar
  24. 24.
    NIH Consensus conference (1993) Gallstones and laparoscopic cholecystectomy JAMA 269:1018–1024CrossRefGoogle Scholar
  25. 25.
    Paxton LD, McKay AC, Mirakhur RK (1995) Prevention of nausea and vomiting after day case gynaecological laparoscopy. A comparison of ondansetron, droperidol, metoclopramide and placebo. Anaesthesia 50:403–406PubMedCrossRefGoogle Scholar
  26. 26.
    Quaynor H, Raeder JC (2002) Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesth Scand 46:109:113PubMedCrossRefGoogle Scholar
  27. 27.
    Splinter WM, Roberts DJ (1997) Prophylaxis for vomiting by children after tonsillectomy: dexamethasone versus perphenazine. Anesth Analg 85:534–537PubMedCrossRefGoogle Scholar
  28. 28.
    Subramaniam B, Madan R, Sadhasivam S, Sennaraj B, Tamilselvan P. Rajeshwari S, Jagan D, Shende D (2001) Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Br J Anaesth 86:84–89PubMedCrossRefGoogle Scholar
  29. 29.
    Tzeng JI, Hsing CH, Chu CC, Chen YH, Wang JJ (2002) Low-dose dexamethasone reduces postoperative nausea and vomiting after epidural morphine: comparison of metoclopramide with saline. J Clin Anesth 14:19–23PubMedCrossRefGoogle Scholar
  30. 30.
    Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC (1999) The prophylactic effect of dexamethasone on postoperative nausea and vomiting undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 89:200–203PubMedCrossRefGoogle Scholar
  31. 31.
    Wang JJ, Ho ST, Liu HS, Ho CM (2000) Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery. Br J Anaesth 84:459–462PubMedGoogle Scholar
  32. 32.
    Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, Ho CM (1999) Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth 83:772–775PubMedGoogle Scholar
  33. 33.
    Watcha MF, White PF (1992) Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 77:162–184PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • V. Nesek-Adam
    • 1
  • E. Grizelj-Stojčić
    • 1
  • Ž. Rašić
    • 2
  • Z. Čala
    • 2
  • V. Mršić
    • 1
  • A. Smiljanić
    • 1
  1. 1.Department of AnesthesiologyResuscitation and Intensive Care, Sveti Duh General HospitalZagrebCroatia
  2. 2.University Department of SurgerySveti Duh General HospitalZagrebCroatia

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