A prospective, randomised, double blind controlled comparative study of antiemetic effects of ramosetron and dexamethasone with ondansetron and dexamethasone combination for prevention of post operati

Introduction: Post operative nausea and vomiting (PONV) is one of the most frequent complications of middle ear surgery that can result in adverse physical and psychological outcomes. Various antiemetic combinations are tried for prophylaxis in high risk patients. Commonly a combination of dexamethasone and 5HT3 antagonists are used as antiemetics for preventing nausea and vomiting. We studied the efficacy of various drug combinations using dexamethasone, ondansetron and ramosetron for prevention of PONV for 24 hours post operatively in patients undergoing middle ear surgery. Aims and Objectives: To study the PONV incidence and to evaluate the efficacy of combination of ramosetron and dexamethasone in comparison to combination of ondansetron and dexamethasone and dexamethasone alone after general anaesthesia in patients undergoing middle ear surgery. Materials and Method: Ninety adult patients of American Society of Anaesthesiologists(ASA) class I and II undergoing middle ear surgery were divided randomly into three equal groups of 30 patients each. Group DO (Dexamethasone 8 mg + Ondansetron 4 mg), Group DR (Dexamethasone 8 mg + Ramosetron 0.3 mg) and Group DS (Dexamethasone 8 mg and saline). The incidence of PONV and severity of PONV, the need for rescue antiemetic therapy were observed at 0-6, 6-12, 12-18 and 18 -24 hours postoperatively. Results: The nausea and vomiting incidence was lower in Group DR in comparision to Group DO (3.33% vs 30% p= 0.044). It was much more lower in comparision to Group DS (3.33% vs 56% p = 0.000) which was highly significant in 0-6 hours postoperatively. Rescue antiemetic therapy requirement was nil in the Group DR, 16.7% in the Group DO and 50% in Group DS. In Group DR the complete response was higher in comparision to Group DO. Conclusion: Ramosetron and dexamethasone combination is preferable to ondansetron and dexamethasone combination for prevention of nausea and vomiting in the post operative period after middle ear surgery.