Prophylactic Anti-Emetic Effect of Dexamethasone and Metoclopramide on the Nausea and Vomiting Induced by Laparoscopic Cholecystectomy: A Randomized, Double Blind, Placebo-Controlled Trial

Abstract

Background: Postoperative nausea and vomiting (PONV) is an unpleasant, distressing and frequent adverse effect after general anesthesia and surgery which has a high incidence in patients undergoing laparoscopic cholecystectomy. While none of the currently available antiemetic drugs are fully effective in all patients, it has been reported that dexamethasone is effective against emesis in patients undergoing general anesthesia. Objectives: This study evaluates the prophylactic anti-emetic effect of dexamethasone in comparison with metoclopramide and placebo for the prevention of post-operative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: In Mostafa Khomeini hospital, a teaching hospital of Shahed University, Tehran, Iran, a randomized, double-blind and placebo-controlled study on 161 patients undergoing general anesthesia for elective laparoscopic cholecystectomy was run.One hundred sixty one patients (124 females and 37 males) requiring general anesthesia for laparoscopic cholecystectomy were studied. The dexamethasone group (n = 53) received dexamethasone 8mg IV, the metoclopramide group (n = 55) received metoclopramide 10mg IV and the placebo group (n = 53) received 2ml saline IV at the induction of anesthesia. Results: In the current study, 26.4 %, 32.7 % and 52.8 % of patients reported vomiting in the dexamethasone, metoclopramide and placebo group (P≤ 0.001), respectively. The total incidence of nausea and vomiting also reduced to 30.2 % with dexamethasone in comparison with 49.1 % in metoclopramide group and 58.5 % in placebo group. (P ≤ 0.001) Conclusions: Dexamethasone 8mg is a better anti-emetic agent than metoclopramide for the prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy.