Dexamethasone and Metoclopramide, and their Combination for the Prevention of Postoperative Nausea and Vomiting in Female Patients Undergoing Laparoscopic Surgery

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Dwaikat, Mohammed
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An-Najah National University
Introduction: No single antiemetic drug has proven to be a universal solution to postoperative nausea and vomiting. There is evidence however, that in patients with a high risk of developing PONV, combination antiemetic therapy is considered to be a viable assistive practise. The aim of this study is to evaluate the effect of prophylactic dexamethasone and metoclopramide as monotherapies and in combination for female patients with moderate to high risk for PONV related to laparoscopic surgery under general anesthesia. Methods:A multicenter, prospective, randomized, double-blind, placebo controlled trial was used in this study.One hundred twenty female patientswere allocated randomly to one of the four groups, with thirty patients in each: (D) group received 8 mg dexamethasone one minute immediately before induction of anesthesia and 10 ml saline before end of anesthesia.,(M) group received 10 ml saline one minute immediately before induction of anesthesia and metoclopramide 20 mg before end of anesthesia, (C) group received dexamethasone (8 mg) one minute immediately before induction of anesthesia and metoclopramide (20 mg) before end of anesthesia, and (P) group received 10 ml saline one minute immediately before induction of anesthesia and 10 ml normal saline before end of anesthesia. Postoperative symptoms were assessed postoperatively. Results: Significant differences in the incidence of vomitingwithin 24 hrs postoperatively between placebo group17 (56.7%) and combination group 6 (20%), P = 0.0037, and dexamethasone group 6 (20%), P = 0.0037 were demonstrated. The results show that the incidence of vomiting was reduced significantly by use of dexamethasone as amonotherapy or in combination with metoclopramide. Significance differences were also noted in the incidence of nausea 24 hrspostoperatively between the treatment groups (D, M, and C) when compared with placebo group p< 0.05. There were no statistical significance differences between the three treatment groups, p>0.05. Results can be interpreted as evidence that using metoclopramide and dexamethasone alone or in combination in this sample decreased the incidence of nausea during the 24 hours after recovery as compared with a non-active placebo. Significant differences were exhibited in the intensity of nausea 24 hours postoperative between the combination group 1.05 (± 0.90) compared with dexamethasone 1.78 (± 1.14), P = 0.008, Metoclopramide 2.43 (± 1.03), P = 0.000 and the placebo group 3.07 (± 1.34), P=0.000. These results demonstrate that using a combination of dexamethasone and metoclopramide canreducs significantly the intensity of nausea in the critical 24 hour postoperative period. There were noted significant differences in need to administer antiemeticin the 24 hour postoperative period.The total number of patients who received the combination therapy 6(20%)and dexamethasone 7(23.3%) required antiemeticat a lower rate than those who received placebo 19(63.3%), p < 0.05. There was no significant difference evidenced between placebo and metoclopramide 13 (43%) p= 0.1237. The results show that use of either dexamethasone or combination reduced significantly the need for additional analgesic medication 24 hours post-operation. Reported incidence of pain24 postoperativein combination therapy was 22 (77.3%) and in the dexamethasone group 21 (70%) compared to the placebo group 29 (96.7%), p< 0.05 and the metoclopramide group 28 (93.3%), p< 0.05. The results indicate that the incidence of pain was reduced significantly in the combination and dexamethasone groups. Conclusion:The combination of dexamethasone plus metoclopramide appears to be a more effective prophylactic in reducing the intensity of nausea than dexamethasone, metoclopramide alone or a placebo. Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV and decreasing the severity of postoperative pain than metoclopramide alone and placebo. Patients who are at high risk for PONV may demonstrate positive results when using a combination therapy. In addition no adverse events related to use were found. Keywords: PONV, Dexamethasone, Metoclopramide, Postoperative symptoms.