Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: Prospective, randomized, and double-blind study

Introduction: Up to 75% of the patients undergoing laparoscopic cholecystectomy develop postoperative nausea and vomiting (PONV). Both ramosetron, a serotonin subtype 3 (5-HT3) antagonist, and dexamethasone are effective for PONV prophylaxis following laparoscopic cholecystectomy but their combined effect has not been investigated. We investigated the efficacy and tolerance of ramosetron alone and ramosetron with dexamethasone for PONV prophylaxis after laparoscopic cholecystectomy. Methods: Seventy six patients scheduled for laparoscopic cholecystectomy were randomized to receive either intravenous (i.v.) 0.3 mg ramosetron (group R), or 8 mg dexamethasone plus 0.3 mg ramosetron (group D). Standardized anesthesia with desflurane and remifentanil was used in all patients. Postoperative nausea, retching, vomiting, rescue antiemetics, pain scores, rescue analgesics and side effects were assessed at 0-2, 2-24 and 24-48 h postoperatively. Results: Seventy two patients were randomized. The overall incidence of PONV did not differ (p = 0.31) but fewer patients needed rescue antiemetics in group D than in groups R (3 vs. 13 patients, respectively; p = 0.01) during 0-48 h postoperatively. Additionally, pain scores were significantly lower in group D during the study period (p < 0.01) and rescue analgesics were required less often in group D during 2-48 h postoperatively (p < 0.01). Conclusions: In patients undergoing laparoscopic cholecystectomy, the combined use of ramosetron and dexamethasone was more effective than ramosetron alone for reducing the need for rescue antiemetics and pain control following the procedure. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.