Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: a randomized clinical trial

Abstract

Background: Dexamethasone has a prophylactic effect on postoperative nausea and vomiting (PONV) and perioperative hydration is believed to play a role in PONV prophylaxis. This study was performed to examine the combined effects of pre-induction dexamethasone plus super-hydration on PONV and pain following laparoscopic cholecystectomy (LC).

Methods: A total of 100 female patients undergoing LC were enrolled and randomized equally into two groups. Group DF received 5 mg dexamethasone (pre-induction) plus 30 ml/kg Ringer's lactate (intraoperative) and group D received 5 mg dexamethasone (pre-induction) alone. Anesthetic and surgical managements were standardized for all patients. The incidence and severity of PONV, and intra and post-operative analgesic and postoperative antiemetic consumption, were assessed during the first 24 h postoperatively. Post-anesthesia care unit (PACU) stay and aggregated 24 h pain scores were calculated.

Results: Group DF had significantly lower PONV than group D (P = 0.03). The number of patients with the lowest PONV score was significantly increased in group DF (P = 0.03). Ondansetron consumption was significantly lower in group DF (P < 0.0001). The mean accumulated 24 h pain scores were significantly lower in group DF compared to group D (P < 0.0001). The time to first analgesic request was significantly longer in group DF than group D (P < 0.0001). In addition, total meperidine consumption during the first postoperative 24 h was significantly lower in group DF than group D (P = 0.002).

Conclusions: In female patients undergoing LC, pre-induction with 5 mg dexamethasone plus intraoperative 30 ml/kg Ringer's lactate solution decreased PONV and pain during the first 24 h postoperatively compared to 5 mg dexamethasone alone.

Keywords: Cholecystectomy; Dexamethasone; Laparoscopy; Pain; Postoperative nausea and vomiting; Super-hydration.

Fig. 1. CONSORT Flow Diagram. DF: dexamethasone plus super-hydration group, D: dexamethasone group.

Fig. 2. Frequency of early (0–6 h) postoperative nausea, retching, and vomiting in both groups. Group DF: Dexamethasone plus hyperhydration group, Group D: Dexamethasone group. No statistical differences between groups were seen for the incidence of nausea, retching, or vomiting during the early postoperative period.

Fig. 3. Frequency of late (6–24 h) postoperative nausea, retching, and vomiting in both groups. Group DF: Dexamethasone plus hyperhydration group, Group D: Dexamethasone group. No significant differences between groups were seen for the occurrence of nausea, retching, or vomiting during the late postoperative period.