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Ondansetron and Dexamethasone Dose Combinations for Prophylaxis Against Postoperative Nausea and Vomiting

Paech, Michael J. DM*; Rucklidge, Matthew W.M. FRCA*; Lain, Jennifer FANZCA*; Dodd, Philip H. FRCA*; Bennett, Emma-Jane MBBS*; Doherty, Dorota A. PhD†

Section Editor(s): Glass, Peter S. A.

doi: 10.1213/01.ane.0000258768.76093.16
Ambulatory Anesthesia: Research Report

BACKGROUND: Patients at high risk of postoperative nausea and vomiting often receive more than one prophylactic antiemetic drug. In this study we sought to determine whether one or more of four dose combinations of dexamethasone and ondansetron was superior in efficacy.

METHODS: In a randomized, double-blind trial of four dose combinations, women having day-surgical gynecologic laparoscopy received IV dexamethasone and ondansetron 4 + 4 mg (Group D4/O4, n = 154), 4 + 2 mg (Group D4/O2, n = 151), 2 + 4 mg (Group D2/O4, n = 154), or 2 + 2 mg (Group D2/O2, n = 155).

RESULTS: The groups were not significantly different for predicted risk or characteristics. The incidence of vomiting until discharge did not differ significantly (5%, 4%, 9% and 8% for Groups D4/O4, D4/O2, D2/O4 and D2/O2 respectively, P = 0.17), nor were there significant differences among groups in the incidence of vomiting until 24 h postoperatively, no nausea and no vomiting, antiemetic treatment, neither vomiting nor antiemetic treatment (80%–83% across groups), or inpatient satisfaction and recovery scores, or time to discharge. Average nausea scores were low in all groups, but the incidence of nausea until 24 h postoperatively was significantly higher among groups receiving only 2 mg of dexamethasone (P < 0.03).

CONCLUSIONS: All combinations were associated with a low incidence of vomiting and rescue treatment, with dexamethasone 2 mg plus ondansetron 2 mg not significantly different to other dose combinations except that groups receiving 2 mg dexamethasone had a more frequent incidence of nausea.

IMPLICATIONS: A prophylactic dose of IV dexamethasone 2 or 4 mg, with ondansetron 2 or 4 mg, prevents nausea and vomiting in two-thirds of patients having day-surgical gynecologic laparoscopy. Combinations did not differ in efficacy, except that patients receiving 2 mg dexamethasone were more likely to have nausea from 0 to 24 h.

From the *Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia; and †Biostatistics and Research Design Unit, Women and Infants Research Foundation, Western Australia.

Accepted for publication December 20, 2006.

Supported by Australian and New Zealand College of Anaesthetists.

Address Correspondence to Michael Paech, DM, Department of Anaesthesia and Pain Medicine, School of Medicine and Pharmacology, The University of Western Australia, King Edward Memorial Hospital for Women, 374 Bagot Rd., Subiaco 6008, Western Australia, Australia. Address e-mail to

Reprints will not be available from the author.

© 2007 International Anesthesia Research Society
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