Muhammad Saeed, Asjad Sharif, Mahmood Akhtar.
Gynaecological surgery.
Professional Med J Jan ;11(4):450-5.

This study evaluated the antiemetic efficacy, costeffectiveness and clinical utility of prophylactic metoclopramide or dexamethasone, alone or in combination, compared with placebo in the prevention of postoperative nausea and vomiting (PONV). DESIGN: A prospective randomized clinical trial. Setting & Period: From July 2003 to March 2004 at CMH Nowshera and Risalpur Patients & Methods: 182 gynaecological patients (25-48 yr, ASA I-II). After induction with intravenous (IV) Thiopental, anaesthesia was maintained with halothane and nitrous oxide in oxygen including relaxation with Pavulon. The patients received IV dexamethasone 8mg, metoclopramide 10 mg or dexamethasone 5 mg IV plus 10mg metoclopramide & placebo. Postoperative analgesia and antiemetic rescue medication were standardized. Results: Episodes of PONV were recorded for the first 24 h after the operation. The incidences of PONV were analyzed with Fisher`s Exact test and the severity of PONV rated by a standardized scoring algorithm. The incidence and severity of PONV in the first 24 h were significantly less in the dexamethasone and metoclopramide combination groups than in individual drugs or placebo group (P<0.05). The reduction of the severity of PONV induced by metoclopramide or dexamethasone alone was not statistically significant (metoclopramide vs placebo: P = 0.27; dexamethasone vs placebo: P = 0.12). PONV was comparable in both the metoclopramide and the dexamethasone group. Conclusion: Good prophylaxis of PONV can be achieved by combination of commonly available drugs dexamethasone with metoclopramide in most gynaecological surgeries, and it is 22 times economical than ondansetron..

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