Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative
nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective,
randomized, and double-blind study.
Author(s): Ryu JH(1), Chang JE, Kim HR, Hwang JW, Oh AY, Do SH.
Affiliation(s): Author information:
(1)Department of Anesthesiology & Pain Medicine, Seoul National University Bundang
Hospital, 166 Kumi-ro, Bundang-gu, Seongnam-si, Kyonggi-do 463-707, Republic of
Korea.
Publication date & source: 2013, Int J Surg. , 11(2):183-7
INTRODUCTION: Up to 75% of the patients undergoing laparoscopic cholecystectomy
develop postoperative nausea and vomiting (PONV). Both ramosetron, a serotonin
subtype 3 (5-HT3) antagonist, and dexamethasone are effective for PONV
prophylaxis following laparoscopic cholecystectomy but their combined effect has
not been investigated. We investigated the efficacy and tolerance of ramosetron
alone and ramosetron with dexamethasone for PONV prophylaxis after laparoscopic
cholecystectomy.
METHODS: Seventy six patients scheduled for laparoscopic cholecystectomy were
randomized to receive either intravenous (i.v.) 0.3 mg ramosetron (group R), or
8 mg dexamethasone plus 0.3 mg ramosetron (group D). Standardized anesthesia with
desflurane and remifentanil was used in all patients. Postoperative nausea,
retching, vomiting, rescue antiemetics, pain scores, rescue analgesics and side
effects were assessed at 0-2, 2-24 and 24-48 h postoperatively.
RESULTS: Seventy two patients were randomized. The overall incidence of PONV did
not differ (p = 0.31) but fewer patients needed rescue antiemetics in group D
than in groups R (3 vs. 13 patients, respectively; p = 0.01) during 0-48 h
postoperatively. Additionally, pain scores were significantly lower in group D
during the study period (p < 0.01) and rescue analgesics were required less often
in group D during 2-48 h postoperatively (p < 0.01).
CONCLUSIONS: In patients undergoing laparoscopic cholecystectomy, the combined
use of ramosetron and dexamethasone was more effective than ramosetron alone for
reducing the need for rescue antiemetics and pain control following the
procedure.
|