A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery.
dc.contributor.author | Szarvas, Szilvia | |
dc.contributor.author | Chellapuri, Ramesh S | |
dc.contributor.author | Harmon, Dominic C | |
dc.contributor.author | Owens, John | |
dc.contributor.author | Murphy, Damian | |
dc.contributor.author | Shorten, George D | |
dc.date.accessioned | 2012-02-03T15:09:24Z | |
dc.date.available | 2012-02-03T15:09:24Z | |
dc.date.issued | 2012-02-03T15:09:24Z | |
dc.identifier.citation | Anesth Analg. 2003 Jul;97(1):259-63, table of contents. | en_GB |
dc.identifier.issn | 0003-2999 (Print) | en_GB |
dc.identifier.issn | 0003-2999 (Linking) | en_GB |
dc.identifier.pmid | 12818978 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10147/208993 | |
dc.description.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. | |
dc.language.iso | eng | en_GB |
dc.subject.mesh | Aged | en_GB |
dc.subject.mesh | Analgesics, Opioid/administration & dosage/*adverse effects/therapeutic use | en_GB |
dc.subject.mesh | Antiemetics/*therapeutic use | en_GB |
dc.subject.mesh | Dexamethasone/*therapeutic use | en_GB |
dc.subject.mesh | Double-Blind Method | en_GB |
dc.subject.mesh | Drug Combinations | en_GB |
dc.subject.mesh | Female | en_GB |
dc.subject.mesh | Humans | en_GB |
dc.subject.mesh | Injections, Spinal | en_GB |
dc.subject.mesh | Male | en_GB |
dc.subject.mesh | Morphine/administration & dosage/*adverse effects/therapeutic use | en_GB |
dc.subject.mesh | Ondansetron/*therapeutic use | en_GB |
dc.subject.mesh | *Orthopedic Procedures | en_GB |
dc.subject.mesh | Pain Measurement/drug effects | en_GB |
dc.subject.mesh | Postoperative Nausea and Vomiting/*prevention & control | en_GB |
dc.subject.mesh | Prospective Studies | en_GB |
dc.subject.mesh | Pruritus/*prevention & control | en_GB |
dc.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. | en_GB |
dc.contributor.department | Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, and University College Cork, Ireland. szarvasszilvia@hotmail.com | en_GB |
dc.identifier.journal | Anesthesia and analgesia | en_GB |
dc.description.province | Munster | |
html.description.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. |