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dc.contributor.authorSzarvas, Szilvia
dc.contributor.authorChellapuri, Ramesh S
dc.contributor.authorHarmon, Dominic C
dc.contributor.authorOwens, John
dc.contributor.authorMurphy, Damian
dc.contributor.authorShorten, George D
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.
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
html.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.


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