Study of the effect of timing of pre-operative administration of dexamethasone and ondansetron on post-operative nausea and vomiting follow laparoscopic cholecystectomy: A prospective randomized control trial

Abstract

: Post-operative nausea and vomiting (PONV) is potential complication in patients after laparoscopic cholecystectomy. The incidence rate of PONV after laparoscopic cholecystectomy (LC) is 46-75% which is higher than that after other types of surgery. The present study was aimed to compare the effect of timing of dexamethasone and ondansetron alone when given 45 minutes before induction or given just before induction of anaesthesia for control of PONV in laparoscopic cholecystectomy. : Tocompare the effect of timing of dexamethasone and ondansetron each when given 45 minutes before induction or given just before induction for control of PONV in laparoscopic cholecystectomy.: After approval by the institutional ethics committee, this study was carried out on 200 patients of both sexes in the age group of 20-60 years. It was a randomized controlled trial. And after obtaining the consent, the patients were allocated in four groups randomly. Group A: 8 mg dexamethasone 45 minutes before induction, Group B: 4 mg ondansetron 45 minutes before induction, Group C: 8 mg dexamethasone just before induction and Group D:4 mg ondansetron just before induction. Patients were observed for 24 hours after surgery for any episode of nausea and vomiting for 24 hours. Patient satisfaction with the management of PONV symptoms using 10 points verbal rating scale was accessed (VRS, 0=not satisfied, 10 = fully satisfied).: Incidence of nausea and vomiting was significantly higher in group B was 68% and D 50% in comparison to group A 28%and C 36% (P=0.003). PONV score was highly significant when ondansetron was administered 45 minutes before induction as compare to dexamethasone when administered 45minutes before induction. The effect of ondansetron was also significant in PONV score of 24 hrs in comparison to dexamethasone.: The ondansetron appears to have a shorter duration of action in comparison to dexamethasone. Timing of administration of ondansetron is important in laparoscopic cholecystectomy before surgery as it has bearing on the incidence of vomiting and rescue antiemetic required. It was found that administration of ondansetron just before induction still delays the onset of PONV in comparison to when given 45 minutes before induction.