EFFICACY OF ONDANSETRON ALONE AND ONDANSETRON PLUS DEXAMETHASONE IN PREVENTING NAUSEA AND VOMITING AFTER MIDDLE EAR SURGERY
AbstractBackground: Post-operative nausea and vomiting is one of the most frequently occurring side effects affecting one third of the cases. Objective of the study was to compare the efficacy of ondansetron alone and ondansetron plus dexamethasone in preventing postoperative nausea and vomiting after middle ear surgery. Methods: This randomized controlled trial was conducted at the Anaesthesia and ENT departments of Ayub Medical College, Abbottabad from January-June 2012. Forty American Society of Anaesthesiologists (ASA) I and 2 physical status patients undergoing middle ear surgery were divided into two groups by blocked randomization. Patients in group-1 (n=20) received ondansetron 4 mg while group-II (n=20) received ondansetron 4 mg with dexamethasone 8 mg just before start of operation. The whole postoperative period of 24 hours was divided into two phases, early 0–6 hours and late phase 6–24 hour. Results: Nausea score and its frequency was significantly higher in Group-I (p<0.05). Vomiting and its frequency were found more in group-I patients. In Group-II, the nausea score was significantly less (p<0.01) at 6 and 24 hours after surgery. The total incidence of vomiting was reduced from 28% in group-1 to 6% in group-II. Rescue antiemetic requirement was significantly less (p<0.01) in group-II. Conclusion: Prophylaxis with a combination of ondansetron and dexamethasone decreased the incidence of nausea and vomiting after middle ear surgery.Keywords: Nausea and vomiting, Middle ear surgery, Dexamethasone, Ondansetron
Fujii Y, Toyooka H. Prophylactic antiemetic therapy with a combination of granisetron and dexamethasone in patients undergoing middle ear surgery. Br J Anaesth 1998;81:754–6.
Reinhart DJ, Klein KW, Schroff E. Transdermal scopolamine for the reduction of postoperative nausea in outpatient ear surgery: a double blind randomized study. Anesth Analog 1994;79:281–4.
Honkavaara P, Saainvaara L, Klemola UK. Prevention of nausea and vomiting with transdermal hyocine in adults after middle ear surgery during general anaesthesia. Br J Anaesth 1994;73:763–6.
Honkavaara P. Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth 1996;76:316–8.
Tsui SL, Ng KFJ, Wong LC, Tang GWK, Pun TC, Yang JCS. Prevention of postoperative nausea and vomiting in gynaecological laprotomies: A comparison of tropisteron and ondansterone. Anaesth Intensive Care 1999;27:471-6.
Chung F, Mezei G. Factors contributing to a prolong stay after ambulatory surgery. Anesth Analog 1999;89:1352–9.
Hirsch J. Impact of postoperative nausea and vomiting in the surgical setting [review]. Anaesthesia 1994;49(suppl):30–3.
Pasternak LR. Anesthetic considerations in otolaryngological and opthalmological outpatient surgery [review]. Int Anesthesiol Clin 1990;28:89–100.
Fisher DM. “The Big Little problem” of postoperative nausea and vomiting: do we know the answer yet? Anesthesiology 1997;87:1271–3.
Al-Khtoum N, Hiari M, Al-Jundi A, Al-Roosan M, Al-Qudah A, Shawakfeh N. Comparitive study of orogastric suction and dexamethasone to reduce vomiting after pediatric tonsillectomy. J Res Med Sci 2009;16(1):16–21.
Palazzo MGA, Strunin L .Anaesthesia and emesis I, etiology. Can Anaesth Soc J 1984;31:178–87.
Lopez-Olaonda L, Carrascosa, F, Pueyo FJ, Monedero P, Busto N, Saez A. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth 1996;76:835–40.
Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response and safety of ondansetron in prevention of PONV: a quantitative systemic review of randamized placebo-controlled trials. Anesthesiology 1997;87:1277–89.
White PF, Watcha MF. Postoperative nausea and vomiting: prophylaxis verses treatment. Anaesth Analg 1999;89:1337–9.
Watcha MF, White PF. Post operative nausea and vomiting. Its treatment and prevention. Anaesthesiology 1992;77:162–84.
Ishizaki H, Pyykkö I, Aalto H, Starck J. Tullio phenomenon and postural stability: experimental study in normal subjects and pa¬tients with vertigo. Ann Otol Rhinol Laryngol 1991;100:976–83.
Thomas R, Jones N. Prospective randomized, double-blind comparative study of dexamethasone, ondansetron and ondansetron plus dexamethasone as prophylactic antiemetic therapy in patients undergoing day-case gynaecological surgery. Br J Anaesth 2001;87:588–92.
Panda NB, Bharadwaj N, Kapoor P, Chari P, Panda NK. Prevention of nausea and vomiting after middle ear surgery: combination of ondansetron and dexamethasoe is the right choice. J Otolaryngol 2004;33:88–92.
Rajeeva V, Bhardwaj N, Batra YK, Dhaliwal LK. Comparison of ondansetron with ondansetron and dexamethasone in prevention of PONV in diagnostic laparoscopy. Can J Anaesth 1999;46:40–4.
Mckenzie R, Tantisira B, Karambelker DJ, Riley TJ, Abdelhady H. Comparison ondansetron with ondansetron plus plus dexamethasone in the prevention of postoperative nausea and vomiting. Anaesth Analg 1994;79:961–4.
Eidi M, Kolahdouzan K, Hosseinzadeh H, Tabaqi R. Comparison of preoperative ondansetron and dexamethasone in prevention of PONV after middle ear surgery. Iran J Med Sci 2012;37(3):166–72.
Beattie WS, Lindblad T, Buckley DN, Forrest JB. The incidence of postoperative nausea and vomiting in women undergoing laparoscopy is influenced by the day of menstrual cycle. Can J Anesth 1991;38:298–302