A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.

Hdl Handle:
http://hdl.handle.net/10147/208993
Title:
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, Szilvia; Chellapuri, 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.com
Citation:
Anesth Analg. 2003 Jul;97(1):259-63, table of contents.
Journal:
Anesthesia and analgesia
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208993
PubMed ID:
12818978
Abstract:
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:
eng
MeSH:
Aged; Analgesics, 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
ISSN:
0003-2999 (Print); 0003-2999 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorSzarvas, Szilviaen_GB
dc.contributor.authorChellapuri, Ramesh Sen_GB
dc.contributor.authorHarmon, Dominic Cen_GB
dc.contributor.authorOwens, Johnen_GB
dc.contributor.authorMurphy, Damianen_GB
dc.contributor.authorShorten, George Den_GB
dc.date.accessioned2012-02-03T15:09:24Z-
dc.date.available2012-02-03T15:09:24Z-
dc.date.issued2012-02-03T15:09:24Z-
dc.identifier.citationAnesth Analg. 2003 Jul;97(1):259-63, table of contents.en_GB
dc.identifier.issn0003-2999 (Print)en_GB
dc.identifier.issn0003-2999 (Linking)en_GB
dc.identifier.pmid12818978en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208993-
dc.description.abstractIn 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.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnalgesics, Opioid/administration & dosage/*adverse effects/therapeutic useen_GB
dc.subject.meshAntiemetics/*therapeutic useen_GB
dc.subject.meshDexamethasone/*therapeutic useen_GB
dc.subject.meshDouble-Blind Methoden_GB
dc.subject.meshDrug Combinationsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInjections, Spinalen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMorphine/administration & dosage/*adverse effects/therapeutic useen_GB
dc.subject.meshOndansetron/*therapeutic useen_GB
dc.subject.mesh*Orthopedic Proceduresen_GB
dc.subject.meshPain Measurement/drug effectsen_GB
dc.subject.meshPostoperative Nausea and Vomiting/*prevention & controlen_GB
dc.subject.meshProspective Studiesen_GB
dc.subject.meshPruritus/*prevention & controlen_GB
dc.titleA comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.en_GB
dc.contributor.departmentDepartment of Anesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. szarvasszilvia@hotmail.comen_GB
dc.identifier.journalAnesthesia and analgesiaen_GB
dc.description.provinceMunster-
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