Dexamethasone versus ondansetron in combination with dexamethasone for the
prophylaxis of postoperative vomiting in pediatric outpatients: a double-blind,
randomized, placebo-controlled clinical trial.
Author(s): de Orange FA, Marques J, Flores M, Borges PS.
Affiliation(s): Teaching and Training Center in Anesthesiology, Instituto de Medicina Integral
Prof. Fernando Figueira, Recife, PE, Brazil. firstname.lastname@example.org
Publication date & source: 2012, Paediatr Anaesth. , 22(9):890-6
OBJECTIVES: To determine the frequency of postoperative vomiting (POV) in
children submitted to outpatient surgery and to compare the efficacy of
antiemetic drugs in preventing this complication.
BACKGROUND: Nausea and vomiting are common in the immediate postoperative period
following anesthetic and surgical procedures. Compared to adults, pediatric
patients are more likely to develop postoperative nausea and vomiting, the
incidence of which ranges from 8.9% to 42%.
METHODS: This double-blind, randomized, placebo-controlled clinical trial
included 129 children. The participants were randomized into three prophylactic
treatment groups: dexamethasone (n = 43), ondansetron in combination with
dexamethasone (n = 44), and placebo (n = 42). The variables studied were the
frequency of POV and the incidence of vomiting after the patient had been
discharged from hospital, the need for antiemetic rescue therapy in the
postanesthesia care unit (PACU), need for hospitalization, and the time the
patient remained in the PACU. A significance level of 5% was adopted.
RESULTS: Postoperative vomiting occurred in 12.4% of the children, with no
statistically significant difference between the groups: 6.8% in the group
receiving ondansetron combined with dexamethasone, 14.3% in the placebo group,
and 14% in the group that received dexamethasone alone (P = 0.47). Furthermore,
no significant difference was found between the groups with respect to the time
the children remained in the PACU, and only five patients reported having vomited
following discharge from hospital.
CONCLUSIONS: The prophylactic use of antiemetic drugs failed to reduce the
incidence of POV in pediatric outpatient surgery with a low emetic potential;
therefore, routine prophylaxis may be unnecessary.