Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized,...

Area of Science:

• Anesthesiology
• Surgical Complications
• Pharmacology

Background:

• Postoperative nausea and vomiting (PONV) are common complications following laparoscopic cholecystectomy (LC).
• Combination antiemetic therapy can improve PONV prevention efficacy compared to monotherapy.
• Targeting different mechanisms of action in combination therapy may enhance outcomes.

Purpose of the Study:

• To compare the efficacy of subhypnotic dose propofol with dexamethasone versus propofol with metoclopramide for PONV prevention after LC.
• To evaluate the impact of these combinations on patient-reported outcomes and rescue antiemetic use.

Main Methods:

• A randomized study involving 60 adult patients undergoing LC.
• Group 1 received propofol (0.5 mg/kg) plus dexamethasone (8 mg).
• Group 2 received propofol (0.5 mg/kg) plus metoclopramide (0.2 mg/kg).
• PONV incidence, severity, and rescue antiemetic use were recorded over 24 hours postoperatively.

Main Results:

• The overall PONV rate was 23.3% in the propofol-dexamethasone group versus 50% in the propofol-metoclopramide group.
• Vomiting frequency was significantly lower in Group 1 (20%) compared to Group 2 (46.7%) within the first 4 hours (P=0.028).
• Rescue antiemetic use was also significantly lower in Group 1 (20% vs 46.7%, P=0.028).
• Mean PONV scale scores were lower in Group 1 (0.4) than Group 2 (1.0) (P=0.017).
• No significant differences in adverse events were observed between groups.

Conclusions:

• Propofol combined with dexamethasone is more effective than propofol with metoclopramide for preventing early PONV in patients undergoing LC.
• This combination offers a promising strategy for managing PONV in the context of LC surgery.
• The findings support the use of dexamethasone in combination regimens for improved PONV control.