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

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    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
    Issue Date
    2012-02-03T15:09:24Z
    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
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    Metadata
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    Citation
    Anesth Analg. 2003 Jul;97(1):259-63, table of contents.
    Journal
    Anesthesia and analgesia
    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
    ISSN
    0003-2999 (Print)
    0003-2999 (Linking)
    Collections
    Cork University Hospital

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