The effects of preoperative rofecoxib, metoclopramide, dexamethasone, and ondansetron on postoperative pain and nausea in patients undergoing elective laparoscopic cholecystectomy.
Author(s): Antonetti M, Kirton O, Bui P, Ademi A, Staff I, Hudson-Civetta JA, Lilly R
Affiliation(s): Department of Surgery, David Grant Medical Center, Travis, AFB CA 94535, USA. mcantonetti@aol.com
Publication date & source: 2007-10, Surg Endosc., 21(10):1855-61. Epub 2007 Aug 18.
Publication type: Randomized Controlled Trial
BACKGROUND: No trial to date has evaluated the combined effect of preoperative Rofecoxib, Metoclopramide, Dexamethasone, and Ondansetron on postoperative pain and nausea in patients undergoing laparoscopic cholecystectomy (LC). METHODS: A prospective randomized double-blinded placebo-controlled trial was conducted on patients undergoing elective LC. The patients in the intervention group received Rofecoxib 25 mg PO. Additionally the study group received Metoclopramide 10 mg and Dexamethasone 4 mg; and Ondansetron 4 mg intravenously. Pain and nausea were rated preoperatively, on arrival at the postanesthesia care unit (PACU), at points until discharge, and at 24 hours. RESULTS: 97 patients were in the control group, and 108 received intervention. The intervention group had a smaller proportion of men (10% vs. 23%; p < 0.015). There were differences in: length of stay (LOS) until discharge criteria met (12.88 vs. 9.85 hours, p = 0.0006), pain rating on arrival to floor (3.55 vs. 2.48, p = 0.003); highest pain rating (4.38 vs. 3.56, p = 0.032), highest nausea rating (2.99 vs. 1.47, p = 0.001), worst nausea since discharge (2.58 vs. 1.26, p = 0.005), and the use of postoperative anti-emetics in women (64% vs. 37.1%, p = 0.001). CONCLUSIONS: The use of this preoperative regimen resulted in decreased LOS, maximum pain, and nausea ratings. Patients in the intervention group required less postoperative anti-emetics.
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