Abstract
Objective:To evaluate the efficacy of Metoclopramide versus Dexamethasone for prevention of postoperative nausea and vomiting during general anesthesia.
 Study Design:This is a Randomized control trial (RCT) study.
 Setting: Study carried out at Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Clinic, Dow University of Health Sciences and Dr. Ruth Pfau Hospital Karachi, from December 2018 to June 2019.
 Materials and Methods:110 patients undergoing elective surgeries, who fulfilled the inclusion criteria and gave informed consent were included in the study. They were randomly assigned to either group M or group D, with 55 patients in each group. All patients were then administered either intravenous dexamethasone (8mg) in group D or intravenous metoclopramide (10mg) in group M at the time of induction of anesthesia. The main outcome measure was postoperative nausea and vomiting, at the end of 6th hour postoperatively. The SPSS version 21 was applied to the data.
 Results: Majority of the patients 66 (60%) were of age 35 years or less. Mean age of the patients was 35.09±11.55 years. There were more females than males, with male to female ratio being 1:1.03. Overall, in patients receiving metoclopramide, 12(21.8%) had postoperative nausea and vomiting, while in patients who received dexamethasone, only 4 (7.3%) patients had post-operative nausea and vomiting. When comparing two groups, there was statistically significant (p= 0.02) reduced postoperative nausea/vomiting among those patients who had received intravenous dexamethasone.
 Conclusion: Intravenous dexamethasone is more effective than Metoclopramide in preventing postoperative nausea and vomiting in patients during general anesthesia.
Highlights
Postoperative common complications of anaesthesia are nausea and vomiting [1]
Some studies shows prophylactic injection of certain drugs are prevented postoperative nausea and vomiting [6].Global drug shortages have limited access to commonly used drugs to prevent Postoperative nausea and vomiting (PONV) such as Ondansetron and Dexamethasone [7] .Dexamethasone and Metoclopramide have been used separately for this purpose, and several studies have shown their effectiveness in reducing postoperative nausea and vomiting [8]
& II,undergoing general anesthesia for procedures lasting between 60-120 minutes were included in the study .Emergency cases,patients with known contraindications for Metoclopramide and Dexamethasone, patients with any signs of extra pyramidal motor disease, malignant hyperthermia, hepatic insufficiency, or epilepsy and surgical cases with intended or probable postoperative administration of propofol, artificial respiration, or stomach tube and use of antiemetics during the past 24 hours or a positive history of motion sickness or PONV were excluded from the study
Summary
Around one-third of patients were reported Postoperative nausea and vomiting (PONV) after general anesthesia [2]. The Society for Ambulatory Anesthesia (SAMBA) guidelines for the management of PONV recommends a prophylactic dose of Dexamethasone 4 mg to 5 mg for patients at high risk of PONV regardless of the surgical procedure. A previous system review, evaluating patients undergoing several surgical procedures, did not address the effect of different doses of Dexamethasone on PONV [13]. An international study reported which Metoclopramide and dexamethasone were compared in the prevention of postoperative nausea and vomiting. The study showed that there was significant difference among the groups in the early postoperative period (0-6 hours) in the incidence of moderate to severe nausea in the dexamethasone group 9.0 % compared to the Metoclopramide group 27.2%. There was a significant difference among the groups in incidence of vomiting, in dexamethasone was 0% compared with 18.1% in Metoclopramide group [14]
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