Evidence Based Practice and Quality Assurance
Background and Goal of Study: Post operative nausea and vomiting (PONV) are common adverse events following surgery and is very distressing to the patient. The concept of balanced antiemesis using combination of antiemetic drugs has gained popularity in recent years and has been successfully used in gynecological surgery (1). Our intention was to examine whether the same benefits extended to patients undergoing breast surgery.
Materials and Methods: Following ethics committee approval and written informed consent 90 patients undergoing elective breast surgery were included in the study. The patients were randomly allocated into 3 groups to receive either placebo or dexamethasone 4 mg + ondansetron 4mg or ondansetron 4 mg + cyclizine 50 mg. The drugs were administered intravenously at induction of anaesthesia in a double blind fashion. A standardized anaesthetic technique was used. Diclofenac suppository and Bupivacaine 0.5% infiltration was used to supplement analgesia. Prochlorperazine 12.5 mg was used as the rescue antiemetic in the recovery room. Patients were asked if nausea or vomiting had occurred in three time periods (0-3, 3-12 or 12-24 hours postoperatively with only 2 possible answers (yes/no). Continuous data was analysed using Student's t test and ANOVA and other data was analysed using Chi-squared test.
Results and Discussions:
Conclusion(s): The combination of dexamethasone and ondansetron significantly decreased the incidence of nausea and vomiting after breast surgery.
1 Ahmed AB, Hobbs GJ, Curran JP. BJA 2000;85:675-82.