Comparative study of efficacy of intravenous dexamethasone and glycopyrrolate in prevention of PONV with intrathecal bupivacaine with morphine, in lower abdominal surgeries: A prospective randomised double blind study

Abstract

Introduction: Intrathecal Morphine as adjuvant can provide safe and effective post-operative analgesia for up to 24 hours. Incidence of post-operative nausea vomiting (PONV) after spinal anesthesia is 21%, which increases to 50% when we add opioid (morphine) adjuvant. This study is oriented to search a remedy for PONV and to compare the efficacy of intravenous Dexamethasone and Glycopyrrolate given preoperatively in prevention of PONV with intrathecal hyperbaric bupivacaine with morphine, in lower abdominal surgeries. Methods: After Ethical committee clearance, Informed written consent was obtained from 60 ASA I or II patients, between ages 18 and 65 years undergoing surgery under spinal anaesthesia and randomized into two groups to receive either injection Dexamethasone 8 mg (Group D) or injection Glycopyrrolate 0.2 mg (Group G) 15 minutes prior to spinal anesthesia with injection bupivacaine 0.5% hyperbaric 15 mg with 100 micrograms preservative free morphine and observed for complete responders, number of episodes of vomiting post operatively over 48 hrs. Pain and sedation assessed by Visual analogue score & Ramsey Sedation Scale respectively. Injection ondansetron 4 mg is used as rescue drug. Results: Demographic data and hemodynamic variables were similar in all the groups. The incidence of PONV in Glycopyrrolate group was 16% & in Dexamethasone group was 12% with p value 0.5 which was similar. Conclusion: The efficacy of premedication with i.v. Dexamethasone or Glycopyrrolate in lower abdominal surgeries in prevention of PONV was comparable.