A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.
Authors
Szarvas, SzilviaChellapuri, Ramesh S
Harmon, Dominic C
Owens, John
Murphy, Damian
Shorten, George D
Affiliation
Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. szarvasszilvia@hotmail.comIssue Date
2012-02-03T15:09:24ZMeSH
AgedAnalgesics, Opioid/administration & dosage/*adverse effects/therapeutic use
Antiemetics/*therapeutic use
Dexamethasone/*therapeutic use
Double-Blind Method
Drug Combinations
Female
Humans
Injections, Spinal
Male
Morphine/administration & dosage/*adverse effects/therapeutic use
Ondansetron/*therapeutic use
*Orthopedic Procedures
Pain Measurement/drug effects
Postoperative Nausea and Vomiting/*prevention & control
Prospective Studies
Pruritus/*prevention & control
Metadata
Show full item recordCitation
Anesth Analg. 2003 Jul;97(1):259-63, table of contents.Journal
Anesthesia and analgesiaPubMed ID
12818978Abstract
In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) ondansetron 8 mg, and (c) dexamethasone 8 mg plus ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, ondansetron 8 mg, and dexamethasone 8 mg plus ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with ondansetron 4 mg has no added benefit compared with ondansetron 8 mg alone in the prophylaxis of PONV and pruritus. IMPLICATIONS: Postoperative nausea and vomiting (PONV) and pruritus are common side effects after spinal opioid administration. In this study, dexamethasone 8 mg plus ondansetron 4 mg was as effective as ondansetron 8 mg. The administration of dexamethasone alone was associated with a frequent incidence of PONV, demonstrating a lack of efficacy. This has important cost implications.Language
engISSN
0003-2999 (Print)0003-2999 (Linking)
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