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

Miok Nam; Haesang Yoon

doi:10.4040/jkan.2009.39.1.44

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

Original Article

J Korean Acad Nurs 2009;39(1):44-52.

Published online: 17 February 2009

DOI: https://doi.org/10.4040/jkan.2009.39.1.44

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

Miok Nam¹, Haesang Yoon^2,

¹Head Nurse, Department of Nursing, Gil Medical Center

²Professor, Department of Nursing, Gachon University of Medicine & Science, Incheon, Korea

Address reprint requests to : Yoon, Haesang, Department of Nursing, Gachon University of Medicine & Science, 534-2 Yeonsu-dong, Yeonsu-gu, Incheon 406-812, Korea Tel: 82-32-820-4212 Fax: 82-32-820-4201 E-mail: hsyoon@gachon.ac.kr

Received 7 May 2008 Revised 13 May 2008 Accepted 14 January 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Ondansetron, Dexamethasone, Postoperative nausea and vomiting, Postoperative pain

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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
Marital status	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
Morning sickness	No	7 (14)	6 (12)
Smoking	Yes	3 (6)	0 (0)	3.191	.235
Smoking	No	22 (44)	25 (50)
Past history of operations	Yes	10 (20)	13 (26)	0.725	.571
Past history of operations	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.

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