Combination of dexamethasone and ondansetron in prophylaxis nausea and vomiting in gynecological operation
Main Article Content
Keywords
dexamethasone, gynecological operation, nausea, ondansetron, vomiting
Abstract
Background: Postoperative nausea and vomiting occur in about 20–30% of women; however, some reports have estimated the rate at 70% in at-risk individuals. Gynecological and obstetrical operations are among the most frequent types of surgeries to be associated with nausea and vomiting postoperatively.Ondansetron and dexamethasone have been compared in a variety of studies for postoperative prophylaxis.
Aim of the Study: This study was conducted in order to compare the efficacy and safety of dexamethasone and ondansetron, alone or in combination, for prevention of postoperative nausea and vomiting in a sample of Iraqi women undergoing gynecological surgeries.
Patients and Methods: The study was conducted in Al-Diwaniyah Province, a region belonging to the Mid-Euphrates sector of Iraq, at the Child and Maternity Teaching Hospital. The study started in June 2021 and the work with the research was accomplished in September 2022. The study included a total of 100 women undergoing different gynecological surgeries such as ovarian cystectomy, oophorectomy, ectopic pregnancy, total abdominal hysterectomy, and myomectomy. All participants involved in the study were categorized randomly into four groups, namely, dexamethasone, ondansetron, combined, and placebo groups.
Results: The rates of nausea in the different groups were analyzed. The rates of nausea in dexamethasone, ondansetron, and combined groups revealed a significant decrease compared with that of placebo group (P < 0.05), and the rate was significantly lower in combined group when compared with dexamethasone and ondansetron groups (P < 0.05). The rate of nausea in combined group was significantly lower than that of dexamethasone and ondansetron groups. The rate of vomiting in combined group was significantly lower than that of placebo group and less than that of the dexamethasone group (P < 0.05).
Conclusion: Based on our study and previous reports, both dexamethasone and ondansetron are efficient and safe in preventing nausea and vomiting in gynecological operations; however, combination of both provides the best results.
References
2. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A sim-ple yet complex problem. Anesth Essays Res. 2016;10(3):388–96. ht t ps://doi.org /10.4103/0259-1162 .179310
3. Moon YE. Postoperative nausea and vomiting. Korean J Anesthesiol. 2014;67(3):164–70.
htt ps://doi.org/10.4097/kjae.2014.67.3.164
4. Ugochukwu O, Adaobi A, Ewah R, Obioma O. Postoperative nausea and vomiting in a gyneco-logical and obstetrical population in South Eastern Nigeria. Pan Afr Med J. 2010;7:6. htt ps://doi.o r g /10.4314/ p a mj.v7i1.69111
5. Nielson M, Olsen NV. Genetic polymorphy-ism in the cytochrome P450 system and effi-cacy of 5-hydroxy-tryptamine type 3 receptor antagonists for postoperative nausea and vomit-ing. Br J Anaesth. 2008;101(4):441–5.
htt ps://doi.org/10.1093/bja/aen246
6. Teunkens A, Vanhaecht K, Vermeulen K, Fieuws S, Van de Velde M, Rex S, et al. Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study. J Clin Anesth. 2017;43:15–23. https://doi.org/10.1016/j.jclinane.2017.09.007
7. Fernández-Guisasola J, Gómez-Arnau JI, Cabrera Y, García del Valle S. Association of nitrous oxide and the incidence of post operative nausea and vomiting in adult—A systemic review and met analysis. Anaesthesia.2010;65(4):379–87. ht t p s: //d oi.o r g /10.1111/j.1365 -20 4 4. 2010.0 62 49. x
8. Echeverria-Villalobos M, Fiorda-Diaz J, Uribe A, Bergese SD. Postoperative nausea and vomiting in female patients undergoing breast and gynecologi-cal surgery: A narrative review of risk factors and prophylaxis. Front Med (Lausanne). 2022;9:909982. https://doi.org/10.3389/fmed.2022.909982
9. Krieser KA, Riley III JB, Baus JE, Hoffman JT, Sullivan JN. PONV Prophylaxis failure disproportionately affects female patients, despite intraoperative computerized decision support guidance. Graduate Med Edu Res J. 2020;2:6. https://doi.org/10.32873/unmc.dc.gmerj.2.1.091
10. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth.2000;84(4):463–7.htt ps://doi.org/10.1093/oxfordjournals.bja.a013471
11. van den Bosch J, Moons K, Bonsel G, Kalkman C. Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting. Anesth Analg.2005;100:1525–32.htt ps://doi.org/10.1213/01.ANE.0000149325.20542.D4
12. Mraovic B, Simurina T, Sonicki Z, Skitarelic N, Gyan TJ. The dose response of nitrous oxide used in postoperative nausea in patients undergoing gyne-cologic laparoscogric surgery—A preliminary study. Anesth Analg. 2008;107(3):818–23. htt ps://doi.org /10.1213/a ne.0b 013e318181f4a a
13. Apfel C, Heidrich F, Jukar-Rao S, Jalota L, Hornuss C, Whelan R, et al. Evidence-based anal-ysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109:742–53. htt ps://doi.org /10.1093/ bja /aes276
14. Smith CA, Ruth-Sahd L. Reducing the incidence of postoperative nausea and vomiting begins with risk screening: An evaluation of the evidence. J Perianesth Nurs. 2016;31:158–71. htt ps://doi.org /10.1016/j.jopan.2015.03.011
15. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118:85–113. htt ps://doi.org/10.1213/ANE.0000000000000002
16. Xu L, Xie X, Gu X. Dexamethasone for preventing postoperative nausea and vomiting after mastec-tomy. Medicine (Baltimore). 2020;99(30):e21417. https://doi.org/10.1097/MD.0000000000021417
17. Fujii Y, Tanaka H, Toyooka H. The effects of dexamethasone on antiemetics in female patients undergoing gynecologic surgery. Anesth Analg. 2012;115:920.https://doi.org/10.1213/ANE.0b013e318271c262
18. Karanicolas PJ, Smith SE, Kanbur B, Davies B, Guyatt GH. The impact of prophylactic dexamethasone on nausea and vomiting after lap-aroscopic cholecystectomy: A systematic review and meta-analysis. Ann Surg. 2008;248(5):751–62. https://doi.org/10.1097/SLA.0b013e3181856024
19. Jules-Elysee KM, Lipnitsky JY, Patel N, Anastasian G, Wilfred SE, Urban MK, et al. Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement. Reg Anesth Pain Med. 2011;36(1):36–40. htt ps://doi.org /10.1097/A A P.0b013e31820306c5
20. Maitra S, Som A, Baidya DK, Bhattacharjee S. Comparison of ondansetron and Dexamethasone for prophylaxis of postoperative nausea and vomit-ing in patients undergoing laparoscopic surgeries: A meta-analysis of randomized controlled tri-als. Anesthesiol Res Pract. 2016;2016:7089454. https://doi.org/10.1155/2016/7089454
21. D’souza N, Swanmi M, Bhaqwat S. Comparative study of dexamethasone and ondansetron for pro-phylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery. Int J Gynaecol Obstet.2011;113(2):12 4 –7. ht t ps://doi.org /10.1016/j.ijgo.2010.11.022
22. Ashwani K, Madhusudan P, Pandove PK, Sharda VK. A randomized, placebo controlled study evaluating preventing role of ondanse-tron, dexamethasone and ondansetron plus dexamethasone for postoperative nausea and vom-iting (PONV) in patients undergoing laparoscopic cholecystectomy. JIMSA. 2013;26(4):217–8.
23. Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2008;22(6):1487–92. ht t ps://doi.org /10.1007/s00464 - 007-9656 -3
24. Mohammad E, Hamid R, Mehdi R, Mahdi M, Abdolreza P. Effect of ondansetron and dexameth-asone on post-operative nauseas and vomiting in patients undergoing laparoscopic cholecystec-tomy. J Minim Invasive Surg Sci.2013;2(2):138–43. https://doi.org/10.5812/jmiss.8450
25. Alghanem SM, Massad IM, Rashed EM, Abu-Ali HM, Daradkeh SS. Optimization of anes-thesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vom-iting. Surg Endosc.2010;24(2):353–8. htt ps://doi.org /10.1007/s00464 - 009- 0567-3
26. Yuksek MS, Alici HA, Erden AF, Cesur M. Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women under-going day-case gynaecological laparoscopic sur-gery. J Int Med Res. 2003;31(6):481–8. htt ps://doi.org/10.1177/147323000303100603
27. Gautam B, Shrestha BR, Lama P, Rai S. Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron–dexamethasone combination compared to ondansetron or dexa-methasone alone for patients undergoing laparo-scopic cholecystectomy. Kathmandu Univ Med J.20 08;6 (23):319 –28.https://doi.org/10.3126/kumj.v 6i 3.170 6
28. Wang XX, Zhou Q, Pan DB, Deng HW, Zhou AG, Huang FR, et al. Dexamethasone versus ondanse-tron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic sur-gery: A meta-analysis of randomized controlled trials. BMC Anesthesiol. 2015;15:118. htt ps://doi.org /10.1186/s12871- 015- 0100 -2
29. Barnes PJ. Anti-inflammatory actions of glucocorticoids: Molecular mechanisms. Clin Sci (Lond).1998;94(6):557–72. ht t ps://doi.org /10.1042/cs0940557
30. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev.2000;21(1):55–89.https://doi.org/10.1210/edrv.21.1.0389
31. Schimmer BP, Parker KL. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs: Inhibitors of the synthe-sis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, editors. Goodman and Gilman’s the pharma-cological basis of therapeutics. 9th ed. New York: McGraw Hill; 1996. pp. 1459–85.
32. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgi-cal outcome after laparoscopic cholecystec-tomy. Ann Surg.2003;238(5):651–60. https://doi.org/10.1097/01.sla.0000094390.82352.cb
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