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[Prevention of post-operative nausea and vomiting. Randomised comparison of dolasetron versus dolasetron plus
S N Piper1, J G Triem, K D Röhm
1Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen. swen.n.piper@t-online.de
Background:
Postoperative nausea and vomiting (PONV) are frequent complications after operations. The aim of this study was to assess the efficacy of combined dolasetron plus dexamethasone versus dolasetron alone with respect to the incidence and severity of emetic symptoms and patients satisfaction.
Methods:
In a prospective, randomised, double-blind study, 150 patients scheduled for hysterectomy or breast surgery were allocated to one of the following two groups: group A received 50 mg dolasetron orally and group B 50 mg dolasetron orally plus 8 mg dexamethasone intravenously. The follow-up was for 24 h after surgery.
Results:
In group A PONV was significantly more frequent (28%) compared to group B (12.0%). The incidence of vomiting was significantly lower in patients receiving dolasetron plus dexamethasone (0%) in comparison to patients receiving dolasetron (8.0%). Furthermore,patients satisfaction was significantly higher in group B compared to group A. About 6 or 7 patients need to be treated with additional dexamethasone instead of a placebo for one patient to benefit from this intervention (i.e. to stay free from PONV) who otherwise would have suffered from PONV.
Conclusions:
Combining oral dolasetron with intravenous dexamethasone further improves the antiemetic efficacy of dolasetron. With a number-needed-to-treat of about 6 the additional benefit might be considered clinically relevant.