Comparison of Granisetron and Dexamethasone in management of post operative nausea and vomiting (PONV) in laparoscopic gynaecological surgery

Background: Postoperative nausea and vomiting (PONV) is a common problem. It is more common inlaparoscopic surgery than in open surgery and following laparoscopic gynaecological surgery. PONVcauses patient discomfort and can prolong the time of hospital discharge.It causes potential hospitalburden and loss of unanticipated working time both for the patients and doctors. Management of thisproblem based on prevention rather than treatment. Various antiemetic drugs including steroids areeffective in the prevention of PONV but which one is better still now a debateable one. On the basis of thisfact there were numerous research, articles, analysis and publication work done all over the world. Objectives: Comparison of granisetron and dexamethasone to detect which one is better in managementof PONV after laparoscopic surgery. Method: The patient were selected after ethical committee approval. After informed written consent wehave selected 100 ASA- I & II patients undergoing general anaesthesia for laparoscopic gynaecologicalsurgery in a prospective double blind randomized study. Patients who had received opoids, NSAIDS,steroids or antiemetic agent before previous 4 weeks or who has known hypersensitivity to granisetron ordexamethasone. Patients were divided as group-A (granisetron) and Group-B(dexamethasone). 50 patientwere member of each group. Every patient got study drug during induction. Group-A got granisetron andgroup-B got dexamethasone for prevention of PONV. There were no differences in background factors orfactors related to anaesthesia, analgesics consumption, pain or side effects between groups. The data collectedin a fixed protocol form from the patient consented for the study. After collection of data were coded, edited,compiled and entered into computer system for analysis. The result will help to guide the anaesthesiologistspracticing in the third world countries like Bangladesh in the management of PONV. Results: The current study showed the intravenous injection of 8 mg dexamethasone, or 3 mg Granisetronhave similar effects on PONV prophylaxis in laparoscopic gynaecological surgery. These results of thecurrent study indicated that Dexamethasone is a suitable substitute for Granisetron. Conclusion: Dexamethasone and Granisetron are comparable in management of PONV. These drugsinjection before anesthesia induction have similar effects on nausea and vomiting prophylaxis afterlaparoscopic gynaecological surgery. Prophylactic use of dexamethasone should be routine to preventPONV because dexamethasone is cost effective than granisetron. JBSA 2020; 33(1): 36-42

[1]  A. Alam,et al.  Effect of peroperative use of granisetron and ondansetron on postoperative nausea and vomiting a comparative study , 2014 .

[2]  M. Terasaki,et al.  Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystectomy: a prospective randomized double-blind study. , 2009, Journal of hepato-biliary-pancreatic surgery.

[3]  E. Erhan,et al.  Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy , 2008, Surgical Endoscopy.

[4]  T. Gan,et al.  Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting , 2006, Current opinion in anaesthesiology.

[5]  R. Ragazzi,et al.  Randomized clinical trial of the effect of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy , 2006, The British journal of surgery.

[6]  Stuart J Pocock,et al.  Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study , 2004, BMJ : British Medical Journal.

[7]  A. Banerjee,et al.  Comparison of ondansetron and granisetron for prevention of nausea and vomiting following day care gynaecological Laparoscopy , 2003 .

[8]  M. Nafie,et al.  Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[9]  J. Bland,et al.  Effectiveness of acute postoperative pain management: I. Evidence from published data. , 2002, British journal of anaesthesia.

[10]  N Roewer,et al.  Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. , 2002, British journal of anaesthesia.

[11]  M F Watcha,et al.  The cost-effective management of postoperative nausea and vomiting. , 2000, Anesthesiology.

[12]  N Roewer,et al.  A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. , 1999, Anesthesiology.

[13]  T. Ala-Kokko,et al.  Comparison of ondansetron and tropisetron combined with droperidol for the prevention of emesis in women with a history of post-operative nausea and vomiting. , 1999, European journal of anaesthesiology.

[14]  J. Hirsch,et al.  Postoperative Nausea and Vomiting After Discharge from Outpatient Surgery Centers , 1995, Anesthesia and analgesia.

[15]  J. Simon,et al.  Promethazine-induced dystonic reaction. , 1987, Pediatric emergency care.

[16]  A. Harris,et al.  A pharmacokinetic study of granisetron (BRL 43694A), a selective 5-HT3 receptor antagonist: correlation with anti-emetic response , 2004, Cancer Chemotherapy and Pharmacology.

[17]  J. Lerman,et al.  Surgical and patient factors involved in postoperative nausea and vomiting. , 1992, British journal of anaesthesia.

[18]  T. Toscani.  [Postoperative care]. , 1956, Minerva ortopedica.