Comparison Between Antiemetic and Long-Acting Glucocorticoid in Reducing Nausea and Vomiting after Laparoscopic Procedures

Abstract

Background: The overall incidence of postoperative nausea and vomitting (PONV) is estimated to be around 20 to 30% and might peak up to 75% in certain high risk patients. Patients who experience postoperative nausea and vomitting consume more time and resources and require additional care. Objective: To Compare the role of preoperative corticosteroid and metoclopramide administration in reducing postoperative nausea & vomiting in patients undergoing laparoscopic cholecystectomy Patients and Methods: A randomized, double-blind placebo-controlled study included 120 adult patients with gallstone disease scheduled for elective laparoscopic cholecystectomy attended Tikrit Teaching Hospital TTH, during the period from May 2013 to June 2014.The patients were divided into 3 groups, each group with 40 patients .Group (A) was given 8 mg of i.v. dexamethasone at induction of G.A. The 2nd group (B) was given 10 mg of metoclopramide i.v. , while a 2ml of normal saline administered to the control group(C) as placebo.The incidence of nausea and/or vomiting had been reported and compared at 6, and 24 hours postoperatively . Results: The incidence of PONV were 27.5%, 40 % ,& 70 % in groups A, B and C respectively. The grades of vomiting as following : grade 1 in group A (80%) ,B(58%) and C (53%)., whereas grade 2 in group A(20%), B(42%) & C (47%). Requirements for rescue antiemetics: in group A(40%), while in groups B (58 %)which in not significant (p=0.130) and in group C (69%) required rescue antiemetics. Conclusions: Dexamethasone is more effective than metoclopramide in reducing postoperative nausea and vomitting following laparoscopic cholecystectomy