Postoperative nausea and vomiting management in maxillofacial procedures: Dexamethasone combined with metoclopramide

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• 作者：Essam M. Manaa^a ; ^b ; ^{e_manaa@yahoo.com} ; Sameh A. Seif^c ; ^d ; ^{dr_samehseif@yahoo.com}
• 关键词：Dexamethasone ; Metoclopramide ; Nausea ; Vomiting ; PONV
• 刊名：Egyptian Journal of Anaesthesia
• 出版年：2012
• 期刊代码：pca120_11101849
• 类别：med
• 出版时间：April, 2012
• 卷：28
• 期：2
• 页码：163-168
• 文件大小：359 K

摘要

Background

Efficient prevention and management of postoperative nausea and vomiting (PONV) continues to be a concern that needs to be addressed. There was a persistently high incidence of PONV despite prophylaxis with, metoclopramide, droperidol, dimenhydrinate or ondansetron when each was used alone in 鈥榓t risk鈥?patients. Dexamethasone was also used as a stand alone drug in patients undergoing surgery. However, the current opinion questions the role of monotherapy. Drug combinations are deemed to be more useful for balanced anti-emesis. The aim of this study was to evaluate the prophylactic antiemetic effects of the combination dexamethasone-metoclopramide in patients undergoing maxillofacial procedures.

Patients and methods

In this placebo-controlled, double-blind study, 208 outpatients under standardized anesthetic technique were randomized to receive dexamethasone 8 mg before anesthesia induction and metoclopramide, 10 mg at the end of surgery (Group A), dexamethasone 8 mg before anesthesia induction and placebo at the end of surgery (Group B), placebo before anesthesia induction and metoclopramide, 10 mg at the end of surgery (Group C) or placebo before anesthesia induction and at the end of surgery (Group D). Complete response to prophylactic antiemetic medication was defined as no vomiting, no sustained moderate nausea and no requesting of antiemetic drug.

Results

During predischarge period, the number of patients with complete response to prophylactic antiemetic medication was significantly higher in Groups B (90.4%) and A (86.5%) in comparison with Groups D (55.8%) and C (75%). At the 24 h follow-up evaluation, complete response was higher in Group A (96.2%) in comparison with Groups C (67.3%) and D (78.8%).

Conclusions

Dexamethasone-metoclopramide combination is not more effective than administration of dexamethasone alone in the prophylaxis of (PONV).