Effect of dexamethasone versus dexamethasone with granisetron in prevention of nausea and vomiting in caesarian section under spinal anesthesia: a randomized double blind study

Authors

  • Mahashweta Das Dhalai Dist. Hospital Tripura, India
  • Maharabam Binarani Department of Anaesthesiology, RIMS Imphal, Manipur, India
  • Ningthoujam Anita Devi Department of Anaesthesiology, RIMS Imphal, Manipur, India
  • Ashen Jack Meitei Department of Anaesthesiology, RIMS Imphal, Manipur, India
  • Malin Deb Nath Agartala Govt. Medical College, Tripura, India
  • L. Eshori Devi Department of Anaesthesiology, RIMS Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20251302

Keywords:

Caesarean section, Spinal anaesthesia, Post-operative nausea and vomiting

Abstract

Background: Postoperative nausea and vomiting (PONV) are a common occurrence in patients undergoing caesarean section under spinal anaesthesia. It can lead to adverse events like pain, bleeding, dehydration, electrolyte imbalance, aspiration pneumonia etc.

Methods: This study was aimed at comparing the effectiveness of dexamethasone alone with dexamethasone with granisetron in prevention of PONV in patients undergoing caesarean section under spinal anaesthesia. This was a double blinded prospective randomized controlled trial conducted on 60 pregnant mothers undergoing elective caesarean section under spinal anaesthesia. One group of patients (n=30) received dexamethasone 8 mg intravenously whereas the other group received dexamethasone 8 mg plus granisetron 2 mg intravenously after baby was delivered and cord clamped. Patients were then observed for a period of 24 hrs postoperatively.

Results: Upon comparison of PONV score between both groups, at 0-2 hrs dexamethasone-granisetron (PONV 0=50%, 1=33.3%, 2=13.3%, 3=3.3%) showed better control than dexamethasone alone (PONV 0=40%, 1=36.7%, 2=16.7%, 3=6.7%). Similar results were seen at 2-24 hrs with dexamethasone-granisetron (PONV 0=83.3%, 1=16.7%, 2=0%, 3=0%) having better score than dexamethasone (PONV 0=66.7%, 1=26.7%, 2=3.3%, 3=3.3%). Need for rescue antiemetic was less in dexamethasone+granisetron (5 out of 30=16.7%) compared to dexamethasone (10 out of 30=33.3%). No major side effects were seen.

Conclusions: Our study shows that dexamethasone combined with granisetron is a safe and effective prophylactic antiemetic in pregnant ladies undergoing caesarean section under spinal anaesthesia, compared to monotherapy of dexamethasone.

Metrics

Metrics Loading ...

Author Biographies

Mahashweta Das, Dhalai Dist. Hospital Tripura, India

Consultant Anaesthesiologist Dhalai District Hospital Tripura

Ningthoujam Anita Devi, Department of Anaesthesiology, RIMS Imphal, Manipur, India

Professor, Anaesthesiology Department RIMS Imphal

Ashen Jack Meitei, Department of Anaesthesiology, RIMS Imphal, Manipur, India

Associate Professor, Anaesthesiology Department RIMS Imphal

Malin Deb Nath, Agartala Govt. Medical College, Tripura, India

Consultant Anaesthesiologist, Agaratal Medical College Tripura

L. Eshori Devi, Department of Anaesthesiology, RIMS Imphal, Manipur, India

Professor, Anaesthesiology Department RIMS Imphal

References

Demirhan A, Tekelioglu YU, Akkaya A, Ozlu T, Yildiz I, Bayir H, et al. Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia. Afr Health Sci. 2013;13(2):475-82. DOI: https://doi.org/10.4314/ahs.v13i2.39

Mehta P, Vaghela A, Soni B, Vachhrajani P. A comparative study efficacy of ondansetron versus granisetron to prevent perioperative nausea and vomiting among patients undergoing gynaecological surgery under spinal anaesthesia in a tertiary care hospital of western India. NJMR. 2018,8(2):54-7.

Scudrei PE, Conlay LA. Postoperative nausea and vomiting outcome. Int Anaesthesiol Clin 2003;102(2):1884-98.

Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia. 1994;49(1):2-5. DOI: https://doi.org/10.1111/j.1365-2044.1994.tb03575.x

Gan TJ. Risk factors for postoperative nausea and vomiting. Anaesth Analg. 2006;102(6):1884-98. DOI: https://doi.org/10.1213/01.ANE.0000219597.16143.4D

Walker R. ASA and CEPOD scoring. Update in Anaesthesia issue. 2002;5(1):14.

Abouleish AE, Leib ML, Cohen NH: ASA provides examples to each ASA physical status class. ASA Newsletter. 2015;79:38-49. DOI: https://doi.org/10.1097/01.ASM.0001073116.40041.ee

Wang JJ, Ho ST, Tzeng JI, Tang CS: The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anaesth Analg. 2000;91(1):136-9. DOI: https://doi.org/10.1213/00000539-200007000-00025

Ryoo SH, Yoo JH, Kim MG, Lee KH, Kim SI. The effect of combination treatment using palonsetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia. Korean J Anaesthesiol. 2015;68(3):267-73. DOI: https://doi.org/10.4097/kjae.2015.68.3.267

Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy, a comparison of droperidol with saline. Anaesth Analg. 1999;89(1):200-3. DOI: https://doi.org/10.1213/00000539-199907000-00036

Ahmed MK, Mukhtar MM, Radwa MMI. Dexamethasone versus ondansetron on post operative nausea and vomiting in caesarean section. MJMR. 2020;31(2):88-96. DOI: https://doi.org/10.21608/mjmr.2022.220843

Supriya S, Sanni DG, Gautam NS, Narendra SB, Rajesh K. The efficacy and safety of granisetron with ondansetron for prevention of post operative nausea and vomiting in patients undergoing caesarian section under spinal anaesthesia. Asian J of Med Sci. 2024;15(6):10-16. DOI: https://doi.org/10.71152/ajms.v15i6.3604

Loannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control of chemotherapy induced nausea and vomiting: a metanalysis of randomized evidence. J Clin Oncol. 2000;18(19):3409-22. DOI: https://doi.org/10.1200/JCO.2000.18.19.3409

Nikham SU, Khandelwal PN, Gawali UB. Evaluation of granisetron as an antiemetic in patients undergoing abdominal hysterectomy under spinal anaesthesia. Int J Res Med Sci. 2017;5(4):1331-8. DOI: https://doi.org/10.18203/2320-6012.ijrms20170995

Zhou C, Zhu Y, Liu Z, Ruan L. 5-HT3 receptor antagonists for the prevention of postoperative shivering: a meta-analysis. J Int Med Res. 2016;44:1174-81. DOI: https://doi.org/10.1177/0300060516668776

Gupta P, Jain S. postoperative nausea and vomiting prophylaxis: A comparative study of ondansetron, granisetron and granisetron and dexamethasone combination after modified radical mastectomy. Saudi J Anaesth. 2014;8(S1):67-71. DOI: https://doi.org/10.4103/1658-354X.144081

Shaikh SI, Nagarkha D, Hegde G, Marutheesh M. Postoperative nausea and vomiting: a simple yet complex problem. Anesth Essays Res. 2016;10:388-96. DOI: https://doi.org/10.4103/0259-1162.179310

Dabbous AS, Jabbour-Khoury SI, Nasr VG, Moussa AA, Zbeidy RA, Khouzam NE, et al. Dexamethasone with either granisetron or ondansetron for postoperative nausea and vomiting in laparoscopic surgery. Middle East J Anaesthesiol. 2010;20(4);565-70.

Alaa ED, Enas EM. Prophylactic multimodal antiemetic in women undergoing caesarean section under spinal anaesthesia. Egypt J Anaesth. 2011;27(2):107-11. DOI: https://doi.org/10.1016/j.egja.2011.04.003

The Italian Group for Antiemetic Research. Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med. 1995;332(1):1-5. DOI: https://doi.org/10.1056/NEJM199501053320101

Kishore CP, Rao MS, Kooran SP, Arora RK, Roy AB. Comperative study of ondansetron, granisetron and granisetron with dexamethasone for prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscospic cholecystectomy. Indian J Clin Anaesth. 2021;8(2):236-42. DOI: https://doi.org/10.18231/j.ijca.2021.046

Nanjundaswamy NH, Sridhara RB. A comperative study of ondansetron and granisetron in combination with dexamethasone in prophylaxis of postoperative nausea and vomiting (PONV) in laparoscospic cholecystectomies. Int J Res Med Sci. 2018;6:503-8. DOI: https://doi.org/10.18203/2320-6012.ijrms20180288

Michels KB, Rotham KJ. Update on unethical use of placebos in randomized trials. Biosynthetics. 2003;17(2):188-204. DOI: https://doi.org/10.1111/1467-8519.00332

Mitchell C, Cheuk SJ, O’Donnell CM. What is the impact of dexamethasone on postoperative pain in adults undergoing general anaesthesia for elective abdominal surgery: a systematic review and meta-analysis. Perioper Med. 2022;11(1):13. DOI: https://doi.org/10.1186/s13741-022-00243-6

Jining M, Bo S, Xiao L, Danqian C, Dandan P, Zhiping W. Prophylactic granisetron for the prevention of postoperative shivering: a meta-analyses of randomized control trials. Int J Clin Exp Med. 2019;12(9):11027-36.

Downloads

Published

2025-04-29

How to Cite

Das, M., Binarani, M., Anita Devi, N., Meitei, A. J., Deb Nath, M., & Devi, L. E. (2025). Effect of dexamethasone versus dexamethasone with granisetron in prevention of nausea and vomiting in caesarian section under spinal anesthesia: a randomized double blind study. International Journal of Research in Medical Sciences, 13(5), 1997–2003. https://doi.org/10.18203/2320-6012.ijrms20251302

Issue

Section

Original Research Articles