Dexamethasone Improves The Anti-emetic Prophylaxis During Middle Ear Surgery Using Granisetron
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The objectives of this study was to compare the efficacy of granisetron used alone and in combination with dexamethasone for prevention of postoperative nausea and vomiting (PONV) following middle ear surgery (MES). Patients & Methods: The study comprised 90 patients scheduled for MES (tympanoplasty or mastoidectomy) and randomly allocated into 3 equal groups, (n= 30, each); group G: received IV granisetron (3 mg) and group G+D: received IV granisetron (3 mg) and dexamethasone 8 mg or normal saline (Group C) over 60 seconds immediately before induction of general anesthesia. All episodes of PONV were recorded, as frequency and severity, for 3 hours after surgery at the recovery room and every 3 hours for 24 hours after discharge from recovery room. Nausea was scored as 0= nil, 1= mild, 2= moderate, and 3= severe nausea and vomiting was scored as 0= nil, 1= one mouthful vomitus, and 2= more than one mouthful of vomitus. Complete response was defined as percentage of patients did not experience PONV or did not request rescue antietnetics. Patient's requests for rescue anti-emetics and adverse events were recorded. Results : Granisetron had significantly reduced the frequency and score of PONV in group G compared to Group C at 0-3 hrs and 3-24 hrs. Dexamethasone had improved the efficacy of granisetron, so there was a significant reduction of the frequency and score of postoperative nausea in group jG+131 compared both to group C and group G at 0-3 hrs and 3-24 hrs. Complete response was reported in 33 patients (36.7%); 2, 10 and 21 patients in groups C, G and (G+13), respectively, whereas 57 patients (63.3%) requested rescue antiemetic either for nausea only (33 patients), vomiting only (9 patients) or nausea and vomiting (15 patients). There was a significant increase of the frequency of complete response in group [G+D] compared to group C and group G with a non-significantly difference in favor of group G. Seven patients (11.7%); 4 in group G and 3 in group G+D developed side effects; 4 patients had headache, 2 had drowsiness and only one in group G had itching. Conclusion : It could be concluded that prophylaxis therapy with a combination of dexamethasone (8 mg) and granisetron (3 tug) was snore effective than granisetron alone for prophylactic control of PONV in patients undergoing MES.