11: Comparison of intraperitoneal dexamethasone, dexmedetomidine and dexamethasone-dexmedetomidine combination on postoperative nausea, vomiting and analgesics requirement after gynaecological laparoscopy: A randomised clinical trial.

Abstract

Background and Aims:Female patients undergoing laparoscopic gynaecological surgery are more prone to postoperative nausea and vomiting (PONV). We hypothesised that an intraperitoneal administration of dexamethasone, dexmedetomidine and combination would reduce the incidence of PONV and analgesics requirement after laparoscopic hysterectomies.Methods:One hundred ninety-two female patients undergoing laparoscopic hysterectomies were randomly assigned to four groups. Anaesthesia technique was identical in all the groups. Patients in group D1 received dexamethasone 8 mg, group D2 received dexmedetomidine 1 µg/kg, group D3 received dexamethasone 8 mg + dexmedetomidine 1 µg/kg combination and group D4 received 20 ml normal saline intraperitoneally at the end of the procedure, before withdrawal of trocar. The primary outcome was the incidence of PONV experienced by the patients within the 24 h postoperative period. The secondary outcome was the analgesic consumption during the first 24 h after surgery, and the need for rescue antiemetic drugs.Results:The incidence of PONV within first 24 h postoperatively was significantly decreased in D1, D2 and D3 group compared to group D4 (p=0.001), however, there was no significant difference among patients in the D1, D2 and D3 groups. The consumption of paracetamol and rescue antiemetic were significantly higher in the group D4 compared to other intervention groups.Conclusion:Intraperitoneal administration of dexamethasone, dexmedetomidine and combination of dexamethasone-dexmedetomidine in laparoscopic hysterectomies significantly reduces the incidence of PONV and also reduces the postoperative analgesics requirement as compared to control group.Table 3Incidence of postoperative nausea and vomiting 0-24 hGroup D1Group D2Group D3Group D4P valueNausea incidence No39 (84.8)37(82.2)40(87)27(60)0.006 Yes7(15.2)8(17.8)6(13)18(40)Vomiting incidence No39(84.8)36(80)40(87)26(57.8)0.003 Yes7(15.2)9(20)6(13)19(42.2)PONV incidence No38(82.6)35(77.8)39(84.8)24(53.3)0.001 Yes8(17.4)10(22.2)7(15.2)21(46.7)