Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy.

BACKGROUND

Dexamethasone has antiemetic and analgesic effects for various types of surgery. The efficacy of dexamethasone for reducing postoperative nausea and vomiting (PONV) and analgesic requirement has never been evaluated for patients undergoing laparoscopic cholecystectomy (LC).

METHODS

In a prospective, randomized, double-blind, placebo-controlled study, patients intravenously received placebo, dexamethasone 4 mg, or dexamethasone 8 mg immediately before induction of anesthesia. A standard anesthetic technique, including sevoflurane and air in oxygen, was used. Postoperatively, emetic symptoms (nausea, retching, and vomiting) and analgesic requirement were evaluated by an investigator.

RESULTS

The study enrolled 90 patients (38 men and 52 nonpregnant women), with each treatment group comprising 30 patients. The rate of patients experiencing PONV 0-24 h after anesthesia was 60% for the dexamethasone 4 mg group (p = 0.294) and 33% for the dexamethasone 8 mg group (p = 0.01), compared with 70% for the placebo group. The need for indomethacin to relieve intolerable pain was less in the dexamethasone 8 mg group than in the placebo group (p = 0.008) or the dexamethasone 4 mg group (p = 0.029). No difference in analgesic requirement was found between the dexamethasone 4 mg group and the placebo group (p = 0.395). No clinically important adverse effects due to the study drug were observed in any group.

CONCLUSIONS

Prophylactic therapy with dexamethasone 8 mg is effective in reducing PONV and analgesic requirement for patients undergoing LC.