Journal List > J Korean Acad Nurs > v.39(1) > 1002545

Nam and Yoon: Effect of Ondansetron combined with Dexamethasone on Postoperative Nausea & Vomiting and Pain of Patients with Laparoscopic Hysterectomy

Abstract

Purpose:

The purpose of this study was to compare the effects of ondansetron combined with dexamethasone on Post-Operative Nausea and Vomiting (PONV) and pain with ondansetron alone in patients with laparoscopy assisted vaginal hysterectomy under general anesthesia.

Methods:

Data were collected from April 1 through September 30, 2005 using a double blind method. Ondansetron 4 mg and dexamethasone 10 mg were administered to the experimental group (25 patients), and ondansetron 4 mg only to the control group (25 patients). The medications were administered through an intravenous line at the beginning peritoneum suture. PONV by Index of Nausea Vomiting and Retching (INVR), nausea by Visual Analogue Scale (VAS), and pain (VAS) were assessed at postoperative 1 hr, 3 hr, 6 hr, 24 hr, and 48 hr. Data were analyzed using repeated measures ANOVA, and Bonferroni methods.

Results:

The experimental group that received ondansetron combined with dexamethasone had less PONV (p=.048), and nausea (p=.012) than control group that received ondansetron alone. However, there was no difference in pain (p=.557) between the patients in the two groups.

Conclusion:

We conclude that the administration of ondansetron combined with dexamethasone is more effective than the administration of ondansetron alone to reduce PONV in patients with laparoscopic hysterectomy.

REFERENCES

Allen D.., Jorgensen C.., Sims C.1999. Effect of tropisetron on vomiting during patient-controlled analgesia in children. British Journal of Anaesthesia. 83:608–610.
crossref
American Pain Society (APS) Quality of Care Committee.1995. Quality improvement guidelines for the treatment of acute pain and cancer pain. The Journal of the American Medical Association. 274:1874–1880.
Apfel C. C.., Laara E.., Koivuranta M.., Greim C. A.., Roewer N.1999. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology. 91:693–700.
Bisgaard T.., Klarskov B.., Kehlet H.., Rosenberg J.2003. Preoperative dexamethasone improves surgical outcome after laparo-scopic cholecystectomy: A randomized double blind placebo con-trolledtrial. Annals of Surgery. 238:651–660.
Choi D. H.., Ko J. S.., Ahn H. J.., Kim J. A.2005. A Korean predictive model for postoperative nausea and vomiting. Journal of Korean Medical Science. 20:811–815.
crossref
Choi J. Y.., Song J. I.., Chul W. B.., Lee S. P.., Choi Y. D.., Park C. Y., et al2004. A clinical study on 570 cases of laparoscopy assisted vaginal hysterectomy (LAVH). Korean Journal of Obstetrics and Gynecology. 47:1954–1959.
Fujii Y.., Saitoh Y.., Tanaka H.., Toyooka H.2000. Granisetron/ dexamethasone combination for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. European Journal of Anaesthesiology. 17:64–68.
Goll V.., Akca O.., Greif R.., Freitag H.., Arkilic C. F.., Scheck T., et al2001. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesthesia and Analgesia. 92:112–117.
crossref
Kim D. H.1999. The effect of dexamethasone combined with on-dansetronon antiemesis and analgesia during postoperative patient controlled analgesia. Korean Journal of Anesthesiology. 36:469–473.
Kim S. I.., Han T. H.., Kil H. Y.., Lee J. S.., Kim S. C.2000. Prevention of postoperative nausea and vomiting by continuous infusion of subhypnotic propofol in female patients receiving intravenous patient-controlled analgesia. British Journal of Anaes-thesia. 85:898–900.
crossref
Kim Y. J.., Kim J. Y.., Choi I. R.., Kim M. W.., Rhodes V.2000. The index of nausea, vomiting, and retching (Korean translation). Journal of Korean Academy of Adult Nursing. 12:278–284.
Koivuranta M.., Laara E.., Snare L.., Alahuhta S.1997. A sur。 vey of postoperative nausea and vomiting. Anaesthesia. 52:443–449.
Lee H. S.., Song J. H.., Kim T. J.., Han J. U.., Lim H. K.., Shin H., et al2004. Comparison of dexamethasone and ondansetron for the prevention of nausea and vomiting using intravenous patient-controlled analgesia after gynecological surgery. Korean Journal of Anesthesiology. 47:726–731.
Lee S. Y.., Jung S. M.., Han S. G.., Won J. J.., Yu E. S.., Suh C. K., et al2001. A comparison of the efficacy and safety of tropisetron and tropisetron plus dexamethasone as antiemetics for elective thyroidectomy. Korean Journal of Anesthesiology. 40:496–502.
crossref
Liu K.., Hsu C. C.., Chia Y. Y.1998. Effect of dexamethasone on postoperative emesis and pain. British Journal of Anaesthesia. 80:85–86.
crossref
McKenzie R.., Tantisira B.., Karambelkar D. J.., Riley T. J.., Abdel- hady H.1994. Comparison of ondansetron with ondansetron plus dexamethasone in the prevention of postoperative nausea and vomiting. Anesthesia and Analgesia. 79:961–964.
crossref
McKenzie R.., Uy N. T.., Riley T. J.., Hamilton D. L.1996. Droperidol/ondansetron combination controls nausea and vom-itingafter tubal banding. Anesthesia and Analgesia. 83:1218–1222.
Mitchelson F.1992. Pharmacological agents affecting emesis. A review (Part I). Drugs. 43:295–315.
Rhodes V. A.., McDaniel R. W.1999. The index of nausea, vomiting, and retching: A new format of the index of nausea and vomiting. Oncology Nursing Forum. 26:889–894.
Roberts G. W.., Bekker T. B.., Carlsen H. H.., Moffatt C. H.., Slattery P. J.., McClure A. F.2005. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesthesia and Analgesia. 101:1343–1348.
crossref
Rudd J. A.., Bunce K. T.., Naylor R. J.1996. The interaction of dexamethasone with ondansetron on drug-induced emesis in the Ferret. Neuropharmacology. 35:91–97.
crossref
Rung G. W.., Claybon L.., Hord A.., Patel C.., Kallgren M.., Koppel J., et al1997. Intravenous ondansetron for postsurgical opioid-induced nausea and vomiting. Anesthesia and Analgesia. 84:832–838.
crossref
Ryoo H. J.2008. April. Specific practice of nurse anesthetist. Paper presented at the meeting of the Korean nurse anesthetist association. Incheon, Korea:
Seo S. J.., Kim K. H.2003. Effect of low dose dexamethasone upon the prevention of postoperative nausea and vomiting after thyroidectomy. Korean Journal of Anesthesiology. 45:636–640.
crossref
Smith D. B.., Newlands E. S.., Rustin G. J.., Begent R. H.., Howells N.., McQuade B., et al1991. Comparison of ondansetron and ondansetron plus dexamethasone as antiemetic prophylaxis dur-ingcisplatin-containing chemotherapy. Lancet. 338:487–490.
Sukhani R.., Pappas A. L.., Lurie J.., Hotaling A. J.., Park A.., Flud-er E.2002. Ondansetron and dolesetron provide equivalent postoperative vomiting control after ambulatory tonsillectomy in dexamethasone pretreated children. Anesthesia and Analgesia. 95:1230–1235.
Szarvas S.., Chellapuri R. S.., Harmon D. C.., Owens J.., Murphy D.., Shorten G. D.2003. A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesthesia and Analgesia. 97:259–263.
crossref
Watcha M. F.., White P. F.1992. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 77:162–184.

Table 1.
Homogeneity Test for General Characteristics (N=50)
Variables Category Con G (n=25) n (%) Exp G (n=25) n (%) 2 p
Marital status Married 21 (42) 24 (48) 2.000 .349
Unmarried 4 (8) 1 (2)
Religion None 12 (24) 11 (22) 0.406 .816
Catholic & protestant 6 (12) 8 (16)
Buddhism 7 (14) 6 (12)
Morning sickness Yes 18 (36) 19 (38) 0.104 1.00
No 7 (14) 6 (12)
Smoking Yes 3 (6) 0 (0) 3.191 .235
No 22 (44) 25 (50)
Past history of operations Yes 10 (20) 13 (26) 0.725 .571
No 15 (30) 12 (24)

Con G=control group (administration of ondansetron); Exp G=experimental group (administration of ondansetron and dexamethasone).

Table 2.
Homogeneity Test for Physiological Characteristics (N=50)
Variables Con G (n=25) Mean±SD Exp G (n=25) Mean±SD t p
Age (yr) 44.0±4.7 44.5±4.9 −0.386 .701
Body weight (kg) 58.5±6.1 59.6±8.3 −0.526 .601
Duration of surgery (min) 94.2±27.5 88.4±22.5 0.815 .419
Duration of anesthesia (min) 125.6±27.4 120.2±23.8 0.744 .461
NPO time (hr) 14.2±4.2 16.0±5.5 −1.279 .208
Estimated blood loss (mL) 400.0±204.1 374.0±159.5 0.502 .618
Hb (g/dL) 12.2±1.4 11.8±1.7 0.956 .344
Trait anxiety (score) 41.9±9.1 41.2±9.8 0.285 .777
INVR (score) 0.0±0.0 0.0±0.0
Nausea (mm) 0.0±0.0 0.0±0.0
Pain (mm) 0.0±0.0 0.0±0.0

Con G=control group; Exp G=experimental group; NPO=nothing by mouth; Hb=hemoglobin; INVR=Index of Nausea Vomiting and Retching.

Table 3.
Nausea and Vomiting (N=50)
Variable Time Con G (n=25) Mean±SD Exp G (n=25) Mean±SD Source F p
INVR (score) Pre op 0.0±0.0 0.0±0.0 Group 5.67 .021
Post op 24 hr 13.6±8.4 9.0±8.5 Time 34.7 <.001
Post op 48 hr**** � 7.7±8.0 3.3±4.7* � G * T 3.14 .048
Nausea (mm) Pre op 0.0±0.0 0.0±0.0 Group 10.74 .002
Post op 1 hr 1.6±5.7 1.2±4.4 Time 9.56 <.001
Post op 3 hr** �� 14.0±20.2 2.8±6.8* � G * T 3.49 .012
Post op 6 hr** �� 13.6±22.2 5.2±11.6
Post op 24 hr**** �� 24.8±25.2 13.6±21.2
Post op 48 hr** �� 16.4±18.2 3.2±8.0** �

*p<.05; **p<.01; ****p<.001;

comparison between post op 24 hr and each time;

�comparison between post op 1 hr and each time;

comparison between Con G and Exp G. Con G=control group; Exp G=experimental group; INVR=Index of Nausea, Vomiting & Retching; Pre op=preoperative; Post op=postoperative; G * T= Group * Time.

Table 4.
Pain (N=50
Variable Time Con G (n=25) Mean±SD Exp G (n=25) Mean±SD Source F p
Pain (mm) Pre op 0.0±0.0 0.0±0.0 Group 0.704 .406
Post op 1 hr 54.8±1.48 53.2±15.7 Time 281.8 <.001
Post op 3 hr**** �� 40.0±10.0 41.2±13.9 G * T 0.792 .557
Post op 6 hr**** �� 31.2±8.3 26.4±6.4
Post op 24 hr**** �� 20.0±7.1 19.2±7.0
Post op 48 hr**** �� 12.8±9.8 10.4±6.1

****p<.001; �comparison between post op 1 hr and each time.

Con G=control group; Exp G=experimental group; Pre op=preoperative; Post op=postoperative; G * T=Group * Time.

Table 5.
Frequency of Administration of Antiemetics, Analgesics, and Pushing PCA Button for Postoperative 24 hr
Variables Group Mean±SD t p
Antiemetics Con (n=25) 0.4±0.6 1.82 .760
Exp (n=25) 0.1±0.3
Analgesics Con (n=25) 0.3±0.6 0.00 1.00
Exp (n=25) 0.3±0.6
Pushing PCA botton Con (n=25) 3.2±2.3 0.81 .424
Exp (n=25) 2.7±2.3

PCA=Patient Controlled Anesthesia; Con=control; Exp=experimental.

TOOLS
Similar articles