Prophylaxis of postoperative nausea and vomiting with combination of ondansetron and dexametasone in urology: Prophylaxis of postoperative nausea and vomiting

Abstract

Introduction: Postoperative nausea and vomiting is an unpleasant, distressing and exhausting experience for patients. There are inconsistent findings concerning approach to the management of PONV and disagreement as to whether prophylaxis of PONV should be the standard of care. Antiemetic prophylaxis using the ondansetron (serotonin subtype 3 antagonist), that is primarily used in the therapy of chemotherapy-induced nausea and vomiting, alone results in a relative reduction rate of PONV of about 30%. It is also well known that dexamethasone, a corticosteroid, is an effective antiemetic agent with minimal side effect after single dose administration in prevention of PONV. Aim of this study was to evaluate the prophylactic effect of ondansetron combined with dexamethasone to prevent PONV in patients undergoing urological surgery. Methods: 60 patients scheduled for an elective surgery (nephrectomy) were involved in this study. Group one (n = 30) received dexamethasone at dose of 5 mg iv. after induction in general anesthesia and 4 mg iv. ondansetron 15 min before end of surgery. Group two (n = 30) was control group and they recieved only our standard antiemetic drug (metoclopramide) in case of PONV. The patients were observed for PONV symptoms during 24 hours after surgery. PONV in groups were evaluated by following parameters: incidence and intensity of PONV, frequency of emetic episodes, VAS pain and fatigue, rescue emetics, and stay in hospital. Results: There is statistical difference in occurring emetic episodes during first 8 hours postoperatively with no demographic influence on study results. Conclusion: Prophylactic dose ondansetron 4mg i.v. + dexamethason 5mg i.v. is effective combination that significantly reduces incidence of PONV in patients undergoing urological surgery.