ABSTRACT

 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

Conference Title

World Nursing and Healthcare Conference Courtyard by Marriott Stockholm Kungsholmen. June 12-13,2017 Stockholm, Sweden Scientific Program

Conference Country

Sweden

Conference Date

June 12, 2017 - June 13, 2021

Conference Sponsor

An-Najah University