DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20162214

A study of comparing single dose granisetron with combination of granisetron with dexamethasone in preventing postoperative nausea vomiting in laparoscopic cholecystectomies

Dhawal R. Wadaskar, Jyoti S. Magar, Bharati A. Tendolkar

Abstract


Background: Postoperative nausea and vomiting (PONV) remains a vexing problem despite of advances in anaesthesia care. PONV is distressing adverse effect after anaesthesia and surgery, resulting in significant morbidity due to acute discomfort associated with emetic symptoms and longer stays in the recovery room or unexpected hospital admission in ambulatory settings.

Methods: A prospective, randomized, double blind comparative study was conducted to compare the efficacy and adverse effects of injection granisetron 40µg/kg as a single dose and injection granisetron in two different doses (20µg/kg and 40µg/kg) in combination with dexamethasone 160µg/kg for prevention of postoperative nausea and vomiting in patients undergoing general anaesthesia for elective laparoscopic cholecystectomy.

Results: Nausea and vomiting were observed postoperatively at 0, 1, 2, 4, 8, and 24 consecutive hours after patient responded to verbal commands. Intensity of nausea graded verbally with an eleven point score (0-10) with those patients who scored their nausea as zero were termed nausea free, and 10 being most severe. Nausea scores when patient complains of nausea & if patient demand rescue antiemetic for nausea was noted down along with adverse effects if any. The data was analysed by ANOVA followed by unpaired‘t’ test, Chi-square/Fischer exact test or Kruskal Wallis Test.

Conclusions: Granisetron as a single agent in dose 40µg/kg is effective as prophylactic antiemetic in preventing PONV in laparoscopic cholecystectomy whereas addition of dexamethasone 160µg/kg to granisetron significantly increases antiemetic efficacy of the granisetron in both the doses i.e. 20µg/kg and 40µg/kg without increasing any side effect. Granisetron 40µg//kg+injection dexamethasone 160µg/kg is best for antiemetic prophylaxis in highly emetogenic surgeries like laparoscopic cholecystectomy.  Granisetron 20µg/kg + injection dexamethasone can be cost effective alternative for routine antiemetic prophylaxis compared to granisetron 40µg//kg and granisetron 40µg//kg+ injection dexamethasone for all patients undergoing laparoscopic cholecystectomy.

 


Keywords


PONV, Emetic symptoms, Granisetron, Dexamethasone, Rescue antiemetic

Full Text:

PDF

References


Gan TJ, Meyer TA, Apfel CC. Society for ambulatory anaesthesia guidelines for the management of postoperative nausea and vomiting. Anaesthesia Analgesia. 2007;105:1615-28.

Wang JJ, Ho ST, Yen YH. Small dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: A comparison of tropisetron with saline. Anaesthesia Analgesia. 2002;95:229-32.

Sanchez-Ledesma MJ, Lopez-Olaondo L, Pueyo FJ, Carrascosa F, A Ortega. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anaesthesia Analgesia. 2002;95:1590-5.

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. British Journal of Anaesthesia. 2001;87:588-92.

Eberhart LHJ, Mauch M, Morin AM, Wulf H, Geldner G. Impact of a multimodal antiemetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting. Anaesthesia. 2002;57:1022-7.

Gan TJ. Risk factors for postoperative nausea & vomiting. Anaesthesia Analgesia. 2006;102:1884-98.

Myles PS, Hendrata M, Benett AM, Langley M, Buckland MR. PONV: Propofol or Thiopentone: Does choice of induction agent affect outcome? Anaesthesia & Intensive Care. 1996;24:355-9.

Hindle AT. A recent development in the physiology and pharmacology of 5HT3. British Journal of Anaesthesia. 1994;73:397-407.

Mark J, Paul J Hasketh, Somerfield MR, Feyer P, Snow RC, et al. American society of clinical oncology, guideline for antiemetics in oncology update. 2006;24:2932-47.

Fuji Y, Tanaka H, Toyooka H. Reduction of postoperative nausea and vomiting with granisetron. Canadian Journal of Anaesthesia. 1994;41:291-4.

Fuji Y, Tanaka H, Toyooka H. Optimal antiemetic dose of granisetron for preventing postoperative nausea and vomiting. Canadian Journal of Anaesthesia. 1994;41:794-7.

Fuji Y, Tanaka H, Toyooka H. Effective dose of granisetron for preventing postoperative emesis in children. Canadian Journal of Anaesthesia. 1996;43:660-4.

Fuji Y, Tanaka H, Toyooka H. Granisetron in the prevention of nausea and vomiting after middle-ear surgery: a dose ranging study. British Journal of Anaesthesia. 1998;80:764-6.

Mikawa K, Takao Y, Nishina K, Maekawa N, Obara H. The antiemetic efficacy of prophylactic granisetron in gynaecological surgery. Anaesthesia Analgesia. 1995;80:970-4.

Wilson AJ, Diemunsch P, Lindeque BG, Scheinin H, Helbo-Hansen HS, Kroeks MVAM, Kong KL. Single dose intravenous granisetron in the prevention of postoperative nausea and vomiting. British Journal of Anaesthesia. 1996;76:515-8.

Fuji Y, Tanaka H, Toyooka H. Prophylactic antiemetic therapy with a combination of granisetron and dexamethasone in patients undergoing middle ear surgery. British Journal of Anaesthesia. 1998;81:754-6.

Fuji Y, Tanaka H, Toyooka H. The effects of dexamethasone on antiemetics in female patients undergoing gynaecological surgery. Anaesthesia Analgesia. 1997;85:913-7.

Biswas BN, Rudra A. Comparison of granisetron plus dexamethasone for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol scand. 2003;47:79-83.