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Comparison of the Efficacy of Dexamethasone, Ondansetron, and Ondansetron Plus Dexamethasone as Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine



Comparison of the Efficacy of Dexamethasone, Ondansetron, and Ondansetron Plus Dexamethasone as Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine



Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-73



Background: Intrathecal opioids are commonly administered to patients for postoperative pain relief. The incidence of postoperative nausea and vomiting (PONV) and pruritus associated with the use of intrathecal opioids is 60-80%(1) and 20-90% (2), respectively. Both ondansetron and dexamethasone reduce the incidence of PONV and pruritus after intrathecal opioid administration. We hypothesised that the combination therapy of dexamethasone and ondansetron would reduce the incidence of intrathecal opioid induced PONV and pruritus more effectively than monotherapy with either agent alone. Methods: After Institutional Ethics Committee approval, 102 ASA I-III patients scheduled for major orthopaedic surgery were recruited. All patients received 0.25 mg.kg-1 bupivacaine and 0.01 mg.kg-1 morphine intrathecally. Patients were randomised to one of three treatment groups and received: (Group A) dexamethasone 8mg, (Group B) ondansetron 8mg, and (Group C) dexamethasone 8mg and ondansetron 4mg. All treatments were administered intravenously. Patients were interviewed at 30 minutes, 2, 4, 8 and 24 hours following surgery. PONV and pruritus was evaluated using a visual analog scale by a blinded observer. Data was analysed using one way analysis of variance and Chi-square test as appropriate. Results: There were no adverse effects following drug administration. The three groups were similar in terms of age, weight, intrathecal opioid dose and duration of surgery. Combination therapy reduced the incidence of PONV compared to the use of dexamethasone alone (p=0.035). Combination therapy also demonstrated improved pruritus scores at four hours following surgery compared to ondansetron alone (1.98(2.2) vs 2.63(2.7), p=0.018). Conclusion: Combination of ondansetron plus dexamethasone significantly decreased the incidence of intrathecal opioid induced PONV and pruritis compared to monotherapy. The lower dose of ondansetron used in the combination group compared to ondansetron alone group has important cost implications.

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