Title: Comparison of Ondansetron with Dexamethasone in the Prevention of Post Operative Nausea and Vomiting in ENT Surgeries

Authors: Dr Sandhya M S, Dr Sugandha K R

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.167

Abstract

Back ground:  Post-operative nausea and vomiting is a common morbidity observed after anesthesia and surgery. It is of significance especially in the context of day care surgery. PONV is the reason for unanticipated hospital admission, resulting in stress and financial burden. In this prospective double blind study, we have compared the effectiveness of Dexamethasone and Ondansetron in the prevention of PONV.

Materials and Methods: After obtaining approval of the hospital ethical committee and informed consent, 60 adult patients of either sex, scheduled for elective ENT surgeries under general anaesthesia were included in the study. In this prospective double blind study, Group A received Ondansetron 4mg and Group B received Dexamethasone 8mg just before induction of general anesthesia. The antiemetic efficacy and side effects were analyzed. The results of the study were statistically analyzed using the student t test and chi square test.

Results: All episodes of nausea and vomiting in the first 24 hour postoperative period during the interval of 0-6 hrs (early PONV) and 6-12 hours (late PONV) were evaluated by a numeric scoring system of PONV. The entire post operative experience was assessed using an 11 point verbal numeric scoring system (0 = not at all satisfied, 10 = fully satisfied).There is no statistically significant difference between Ondansetron and Dexamethasone in preventing postoperative nausea and vomiting either in the early or late postoperative period. But clinically significant difference was noted between these two groups .ie, when 83.3% had no nausea and vomiting in the Dexamethasone group 93.3% had no nausea and vomiting in Ondansetron group. But in the late postoperative period, Dexamethasone had a better effect, ie, while 86.7% had no vomiting in Ondansetron group, 93.3% were free of vomiting episodes in Dexamethasone group. Patient satisfaction score was also comparable.

Conclusion:  In the prevention of postoperative nausea and vomiting, Ondansetron is clinically better than Dexamethasone in early postoperative period. Dexamethasone is more effective in late postoperative period. Dexamethasone being cheaper and easily available can be considered in prevention of PONV.

Keywords: PONV, Ondansetron, Dexamethasone.

References

  1. Watcha, MF, White PF: Post operative nausea and vomiting: its etiology, treatment and prevention. Anaesthesiology 77: 162-184, 1992.
  2. Kovac AL: Prevention and treatment of post operative nausea and vomiting. Drugs 59: 213-243, 2000.
  3. Brunce, KT and MB Tyres (1992). The role of 5HT in post operative nausea and vomiting. British Journal of Anaesthesia 69 (Supplement!): 60S - 62S.
  4. Grunberg S.M, and P.J.Hesketh (1993) Control of chemotherapy induced emesis. New England Journal of Medicine 399: 1790-1796.
  5. Allan SG, Leonard RCF: Dexamethasone antiemesis and side effects. Lancet 1986; 1. 1035.
  6. Naylor Ri, mall FC. The physiology and pharmacology of post operative nausea and vomiting. Anaesthesia 49: 25, 1994 (suppl).
  7. Kenny GN. Risk factors for post operative nausea and vomiting. Anaesthesia 49: 6-10, 1994 (Suppl).
  8. Thomas, N.Jones. Prospective randomized dTible blind comparative study of Dexamethasone, Ondansetron, and Ondansetron plus Dexamethasone as prophylactic antiemetic therapy in patients undergoing day-case gynaecological surgery. British Journal of Anaesthesia. 2001; 87: 588-592.
  9. Subramaniam, R.Madan, S. Sadhasivam et al. Dexamethasone is a cost effective alternative to Ondansetron in preventing PONV after paediatric strabismus repair British Journal of Anaesthesia 2001; 86:84-89.
  10. Jhi-Jaung Wang, Shung - Tai HV et al. Dexmathasone prophylaxis of nausea and vomiting after epidural morphine for post - cesarean analgesia. Canadian Journal of Anesthesia 2001; 48: 185-190.
  11. Jhi-Jaung Wang, Shung - Jai Ho et al. The effect of timing Dexamethasone administration on its efficacy as a prophylactic antiemetic for post operative Nausea and vomiting. Anaesthesia and analgesia 2000; 91: 136-139.
  12. Khosrou H Naghibi, Hashemi SJ et al. comparison of metoclopramide, Dexamethasone and their combination for prevention of post operative nausea and vomiting in strabismus surgery. Medical Journal of Islamic Academy of Science. 2000 Vol. 13.
  13. Margarita, Coloma, Larry. L Duffy et al. Dexamethasone Facilitates discharge after outpatient anorectal surgery. Anaesthesia and Analgesia 2001; 92: 85-88.

Corresponding Author

Dr Sugandha K R

Associate Professor, Dept. of Anesthesiology

Govt Medical College, Thirvananthapuram, Kerala, India