Dexamethasone combined with other anti-emetics for prophylaxis after laparoscopic cholecystectomy

Background: Following surgery and anesthesia, post-operative nausea and vomiting (PONV) are two of the most common side effects. Dexamethasone has been reported to be effective in reducing the incidence of emesis in patients undergoing chemotherapy. Aim: The aim of the study was to compare the effectiveness of granisetron and dexamethasone in combination with ondansetron and dexamethasone in combination for prophylaxis after laparoscopic cholecystectomy. Materials and methods: This is a prospective study on patients undergoing laparoscopic cholecystectomy consisted of 200 patients. 164 patients completed the study. 82 patients in group 1 and 82 patients in group 2. Patients were randomised in two groups, namely group 1 received granisetron and dexamethasone while group 2 received ondansetron and dexamethasone. Results: Out of 200 patients who initially signed the informed consent form, 164 patients (82 in group 1 and 82 in group 2) completed the study. In this study, Granisetron + Dexamethasone was found to be as effective as when compared to ondansetron + Dexamethasone as at 0-1 hour, 100% of patients in group 1 had no vomiting and 97.56% of patients had no vomiting in group 2. Total response was present in 97.56% in group 1 and 95.12% in group 2. The percentage of patients who received metoclopramide was 8.53% in both the groups. At 1-7 hour, 97.56% of patients in group 1 had no vomiting and 100% of patients had no vomiting in group 2. Total response was present in 96.34% in group 1 and 93.90% in group 2. The percentage of patients who received metoclopramide was 4.87% in group 1 and 2.43% in group 2. At 7-24 hour, 97.56% of patients in group 1 had no vomiting and 100% of patients had no vomiting in group 2. Total response was present in 95.12% in group 1 and 95.12% in group 2. The percentage of patients who received metoclopramide was 2.43% in both the groups. 4 out of 82 patients complained of dizziness in group 1 and 4 out of 82 patients complained of dizziness in group 2. 6 out of 82 patients complained of headache in group 1 and 6 out of 82 patients complained of headache in group 2 in the post anaesthesia care unit. Pain scores in group 1 were at 0-1 hr was 6±2.4, at 1-7 hour was 5.4±0.7 and at 7-24 hour was 3.5±0.9. Pain scores in group 1 were at 0-1 hr was 7±2.3, at 1-7 hour was 5.9±2.7 and at 7-24 hour was 4.5±0.2. In between the two groups, there was no significant difference in the side effects and pain scores. Conclusion: The combination of dexamethasone with either granisetron or ondansetron after induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.