Prevention of nausea and vomiting after middle ear surgery: combination of ondansetron and dexamethasone is the right choice

Abstract

Objective: To determine the efficacy of a combination of ondansetron and dexamethasone in preventing postoperative nausea and vomiting after middle ear surgery compared with ondansetron alone.

Design: A prospective, randomized, double-blind study with prestudy power analysis performed to determine the sample size.

Setting: A tertiary teaching hospital.

Method: One hundred patients undergoing tympanomastoidectomy under general anesthesia were included in the study. Patients in group O (n = 50) received ondansetron 4 mg and those in group OD (n = 50) received ondansetron 4 mg with dexamethasone 8 mg 30 minutes before the end of surgery. All patients were monitored for nausea score, episodes of vomiting, and rescue antiemetic requirement in 48 hours after surgery. The total number of complete responders was calculated. Patients' satisfaction at the end of the study period was also estimated.

Results: In patients receiving combination antiemetic (group OD), the nausea score was significantly less (p < .01) at 6, 12, and 24 hours after surgery. The total incidence of vomiting was reduced from 28% in group O to 6% in group OD. Rescue antiemetic requirement was significantly less (p < .01) in group OD. The number of complete responders significantly improved in the combination group (92% vs 62%). The patients were also found to be more satisfied in this group.

Conclusion: Prophylaxis with a combination of ondansetron and dexamethasone decreased the incidence of nausea and vomiting after middle ear surgery to a minimum and improved patients' satisfaction significantly in the postoperative period.