ABSTRACT BACKGROUND There is evidence that in patients with a high risk of developing Postoperative Nausea and Vomiting (PONV), combination of antiemetics is considered. The aim is to evaluate the effect of prophylactic dexamethasone and metoclopramide as monotherapy and in combination for female patients with moderate-to-high risk for PONV undergoing laparoscopic surgery under general anaesthesia. MATERIALS AND METHODS This was a multicentred, prospective, randomised, double-blind, placebo controlled trial. 120 patients, were allocated randomly to one of the four groups: (D) received 8 mg dexamethasone; (M) received 20 mg Metoclopramide; (C) received dexamethasone (8 mg) and metoclopramide (20 mg); and (P) received saline. All patients were assessed 24 hours for PONV, postoperative symptoms and the need for rescue antiemetic and analgesia. RESULTS In the 24-hour post-operative period, the following results were demonstrated; Significant differences in the incidence of vomiting between placebo group 17 patients (56.7%) and combination group 6 (20%), P = 0.0037, and dexamethasone group 6 (20%), P = 0.0037. The results indicate that incidence of overall vomiting was reduced by use of either Dexamethasone or combination. Also statistically significant differences were noted in the incidence of nausea between the treatment groups [D 6 (20%); M 10 (33.3%); and C 5 (16.7%)] when compared with placebo 19 (63.3%), p< 0.05. The results indicate that the three treatments groups have similar effect in reducing overall incidence of nausea. Significant differences were also exhibited in the intensity of nausea 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 placebo 3.07 (± 1.34), P=0.000. Results demonstrate that using a combination can significantly reduce the intensity of nausea. The total number of patients who received rescue antiemetic in combination 6 (20%) and dexamethasone 7 (23.3%) were significantly lower than those receiving placebo 19 (63.3%), p <0.05. Incidence, intensity of pain and the consumption of rescue analgesic were reduced significantly in the combination and dexamethasone groups compared with Metoclopramide and Placebo. CONCLUSION The combination of dexamethasone plus metoclopramide reduces the intensity of nausea. Dexamethasone and a Dexamethasone plus Metoclopramide was found more effective in preventing PONV and decreasing the requirement of rescue antiemetic than Metoclopramide or placebo. Patients who are at high risk for PONV may demonstrate positive outcomes when using a combination therapy. KEYWORDS Postoperative Nausea and Vomiting, Dexamethasone, Metoclopramide

Title

J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/

Publisher

JEMS.com

Publisher Country

India

Indexing

Thomson Reuters

Impact Factor

1.39

Publication Type

Online only

Volume

6

Year

2017

Pages

5353-5359