Title: A Comparative Study of Ondansetron versus Ondansetron with Dexamethasone in Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing Modified Radical Mastectomy with  Axillary Node  Dissection Under General Anaesthesia

Authors: Sahoo Alok Kumar, Das Prajnyananda, Danta Sachidananda

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i9.11

Abstract

Modified radical mastectomy surgeries used to have high incidence of nausea and vomiting. Ondansetron and Dexamethasone both used to prevent postoperative nausea and vomiting .We evaluated the efficacy of Dexamethasone in combination with ondansetron verses ondensetron alone.

Methods- in a prospective double blind study of 80 patients scheduled for MRM with axillary node clearance taken in to consideration. Group O (n=40) given ondensetron 8mg  alone and  group D(n=40)  given ondensetron 8mg with Dexamethasone 8mg. all patient have standard methods of anaesthesia and mastectomy. Episodes of PONV noted with standard 4 point scale.

Observation and Results- demographic profile in both group are comparable. The PONV lower in Dexamethasone group in first 6hr period( 17.5% vs 40% p<0.05%).

In 6-12 hr, the the PONV in Dexamethasone group is still lower (7.5% vs 20% p>0.05) but it is not statistically significant. In 12to 24 hr 100% patient in Dexamethasone group is completely free of PONV. There is minimal adverse effect of both of these drugs.

Conclusion- Preoperative intravenous Dexamethasone (8 mg) in combination with ondansetron can significantly reduce the incidence of PONV in patients undergoing mastectomy with axillary dissection for breast cancer.

Keywords PONV, MRM, Dexamethasone , ondensetron.

References

 

1.      http://www.breastcancerindia.net/bc/statistics/stat_global.htm

2.      Consensus Guidelines for the Management of Postoperative Nausea and Vomiting Tong J. Gan, MD, MHS, FRCA,* Pierre Diemunsch, MD, PhD

3.      Comparison of ondansetron and combina-tion of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery.Basant Bhattarai,  Santosh Shrestha, and Jeevan Singh

4.      Islam S, Jain P N. Post-operative nausea and vomiting (PONV): A review article. Indian Journal of Anaesthesia, August 2004;48(4):253-258

5.      Biniemof JL. andScudman LT. Anesthesia and Perioperative Complications. Mosby Year Book; 1992:396-410

6.      Dong Chul Lee, The preventative effect of rarnosetron on postoperative nausea and vomiting after total thyroidectomy Korean J Anesthesiol 2011 August 61(2): 154-158.

7.      Vakil JR, Golwala FA. Physical Diagnosis A text book of symptoms and signs. 7th edi. Media promoters and publishers pp.52

8.      Sinclair DR, Chung F, Mezei G: Can postoperative nausea and vomiting be predictted?. Anesthesiology. 1999, 91: 109-118

9.      Jorge Gomez- Hernández, Alba Lorena Orozco-Alatorre1 et al, Preoperative dexamethasone reduces postoperative pain, nausea and vomiting following mastectomy for breast cancer, BMC Cancer 2010, 10:692

10.  S. I. Kirn, S. C. Kirn, Y. H. Baek, S. Y. Ok and S. H. Kirn Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery. Br J Anaesth. 2009;103:549-53.

11.  Tramer MR, Reynolds JM, Moore RA, McQuay HJ. Efficacy, dose–response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;87:1277–89.

12.  L.Lopez-Olaondo, Carrascosa F, Pueyo F J, P Monedero, N Busto, ASaez. Combination of ondansetron and dexamethasone in the prophylaxis of post operative nausea and vomiting.Br J Anaesth. 1996; 76:835-840.

13.  Maulana M. Ansari, Obaid A. Siddiqui, Shahla Haleeml, Rohit Varshney, Sadiq Akhtar, Faroze A. Khan comparison of Ramosetron and Ondansetron for control of post-operative nausea and vomiting following laparoscopic cholecystectomy, Indian Journal of Medical Sciences, Vol. 64, No. 6, June 2010.

14.  Mokhtar Elhakim, MagdyNafie, Khalaf Mahmoud, AzzaAtef Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy .Can J Anaesth. 2002 Nov;49(9):922-6

15.  Thomas R and Jones N. Prospective, randomized, double blind comparative study of dexamethasone, ondansetron and ondansetron plus dexamethasone as prophylactic anti- emetic therapy in patie-nts undergoing day case gynecological surgery. British Journal of Anaesthesia 87(4):588-92(2001) .

16.  Rajeeva,bharadwaj N,Batra et al Comparison of ondensetron with ondens-etron and dexamethasone in prevention of PONV in diagnostic laproscopy; CAN J ANESTH 1999/46:1/40-44

17.  Lopez-Olaondo L, Carrascosa F, and Pueyo FJ. Advances in Antiemetic Pharmacology. 9 RC 4:1-11.

18.  Rusch D. Eberhart M. prospective application of simplified risk score to prevent PONV. Can J Anaesth. 2005, 52:475-484

19.  S. I. Kirn, S. C. Kirn, Y. H. Baek, S. Y. Ok and S. H. Kirn Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery. Br J Anaesth. 2009;103:549-53.

20.  Alain Borgeat, Georgios Ekatodramis, Carlo A. Schenker. A Reviewarticle, Postoperative Nausea and Vomiting in Regional Anesthesia, Anesthesiology 2003; 98:530 - 47.

21.  Geoff Me cracken, Patricia Houston, Guylaine Lefebvre. SOGC Clinical practice guideline, Guideline for the management of postoperative nausea and vomiting, July JOCC Juillet 2008.

Corresponding Author

Sahoo Alok Kumar

Assistant Professor, Dept of Anaesthesiology, S.C.B. Medical College. Cuttack.

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