Evidence-based Practice and Quality Improvement
Background and Goal of Study: Patients undergoing general anesthesia for laparoscopic cholecystectomy have a high risk of postoperative nausea and vomiting (PONV). Ramosetron and dexamethasone have been reported to be effective for the prophylaxis of PONV following laparoscopic cholecystectomy but their synergistic effect has not been investigated. We compared and investigated the effect of ramosetron and ramosetron plus dexamethason on PONV prophylaxis after laparoscopic cholecystectomy.
Materials and Methods: Forty patients scheduled for laparoscopic cholecystectomy were allocated randomly to one of two groups (n = 20 in each) to receive 0.3 mg ramosetron (group I), or 0.3 mg ramosetron plus 8mg dexamethasone (group II) intravenously. Balanced anesthesia with desflurane and remifentanil was used in all patients. Postoperative nausea, retching, vomiting, pain (100 point verbal rating scale, VRS) and side effects were assessed at 2 h, 24 h and 48 h after surgery.
Results and Discussion: No statistical differences were observed among the three groups with regard to patient characteristics and information on surgery and anesthesia. The ratio of PONV was higher in groups I than group II; 35% (n = 7, group I) vs. 5% (n = 1, group II) during the first postoperative 24 h (p = 0.044). In addition, rescue antiemetics were used in significantly fewer patients in group II (n = 1, 5%) than group I (n = 7, 35%) (p = 0.044) during the first 24 h after surgery. In addition, postoperative pain was significantly lower group II than in group I during postoperative 2 h (75 ± 16 in group I vs. 42 ± 26 in group II, p = 0.00). The use of rescue analgesics and the incidences of adverse effect were comparable between the two groups. There was no clinically serious adverse event due to study drugs.
Conclusion(s): Ramosetron plus dexamethasone was more effective than ramosetron alone for the prophylaxis of PONV and postoperative pain control after laparoscopic cholecystectomy (24 h).
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2. Ryu J, So YM, Hwang J, Do SH. Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Surg Endosc.