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

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Ondansetron and Dexamethasone Dose Combinations for Prophylaxis Against Postoperative Nausea and Vomiting
Michael J. Paech,* Matthew W.M. Rucklidge,* Jenniker Lain,* Philip H. Dodd,* Emma-Jane Bennett,* Dorata A. Doherty†
(Anesth Analg, 104:808-814, 2007)
*Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth; and †Biostatistics and Research Design Unit, Women and Infants Research Foundation, Western Australia, Australia
Patients at high risk for nausea and vomiting are often given more than 1 prophylactic antiemetic drug. This study sought to ascertain in a randomized double-blind trial whether 1 or more of 4 dose combinations of dexamethasone and ondansetron had superior efficacy. Women having outpatient gynecologic laparoscopy received intravenous 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). The groups were not markedly different in terms of predicted risk factors or other characteristics. The incidence of vomiting until discharge did not differ substantially (5%, 4%, 9%, and 8% for groups D4/O4, D4/O2, D2/O4, and D2/O2, respectively), nor were there notable differences among groups in the incidence of vomiting until 24 hours postoperatively-no nausea or vomiting, rescue antiemetic treatment, neither vomiting nor antiemetic treatment (80%-83% across groups), patient satisfaction and recovery scores, or time to discharge. Average nausea scores were low in all groups, but the incidence of nausea until 24 hours postoperatively was markedly higher among groups that were given only 2 mg of dexamethasone. All combinations were associated with a low incidence of vomiting and rescue treatment, with dexamethasone 2 mg plus ondansetron 2 mg not markedly different from other dose combinations. However, groups receiving 2 mg dexamethasone more often had nausea.
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