Metoclopramide, versus its combination with dexamethasone in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: A double-blind randomized controlled trial

Abstract

© 2015 Medical Association of Thailand.All rights reserved. Background: Postoperative nausea and vomiting (PONV) are significant problems in laparoscopic surgery. Objective: Compare the prophylactic use of metoclopramide and its combination with dexamethasone in the prevention of PONV in patients undergoing laparoscopic cholecystectomy (LC). Material and Method: One hundred patients aged 18 to 75 with American Society of Anesthesiologists (ASA) class 1-2 who candidates for elective LC at Chiang Mai University Hospital, were included in this double-blind, randomized controlled trial (parallel design). Patients were randomly divided into two groups, by ‘Block of four’ randomization. Treatment group received 8 mg dexamethasone and 10 mg metoclopramide, and control group received 10 mg metoclopramide and normal saline solution 1.6 ml. These medications were administered intravenously when the gallbladder was removed from gallbladder bed. All of investigators, anesthetists, patients, care providers, and outcome assessor were blinded. Patients were asked to assess their nausea and vomiting at 2, 6, 12, and 24 hours postoperatively, and at discharge. The overall score of PONV in each patient based on a four-point whole number of nausea and vomiting by verbal rating scale 0-3 (0 = no nausea and vomiting, 1 = nausea, 2 = nausea with vomiting, and 3 = repeated vomiting ≥2 times). Results: Fifty eligible patients were randomized to each group, and all were analyzed. There were no significant differences between baseline characteristics of patients in the two groups. The combination of dexamethasone and metoclopramide indicated a greater antiemetic effect with significant statistical analysis, odds ratio = 0.25 (95% confidence interval 0.11-0.55, p = 0.001). The postoperative hospital stay in the combined group and metoclopramide group were, 1 day = 47 (94%) and 37 (74%), >1 day = 3 (6%) and 13 (26%), respectively (p = 0.012). There were no postoperative complications occurred in both groups. Conclusion: Intravenous administration of dexamethasone combined with metoclopramide had significant effects in prophylaxis of nausea and vomiting after LC and shorten the hospital stay.