Title: Ramosetron vs Ramosetron with Dexmedetomidine for Prevention of Postoperative Nausea Vomiting and Shivering after Gynaecological Laparoscopic Surgery: A Comparative Study
Authors: Anjum Naz* MD, Subhadip Maiti MD, Hasibul Hasan Shirazee MD FNB, Bijoy Kumar Bandyopadhyay MD
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.195
Abstract
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Background: Postoperative nausea and vomiting (PONV) and postanesthetic shivering (PAS) are common postoperative patient complaints that can be very distressing and may result in adverse physical outcomes. A combination therapy is more effective in dealing with PONV owing to its multifactorial etiology. Some antiemetics are reported to be effective in the management of PONV as well as PAS and pain. We evaluated the efficacy of dexmedetomidine added to ramosetron for prevention of PONV and shivering after gynaecological laparoscopic surgery. Methods: One hundred and sixty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to two groups. The patients of first group (group R, n = 80) were given ramosetron 0.3 mg and 50 ml normal saline; and the patients of second group (group D, n = 80) were given ramosetron 0.3 mg and 1µ/kg dexmedetomidine diluted in 50 ml normal saline before anaesthesia. Results: Incidence of nausea, emesis and the need for rescue antiemetics was lesser in group D but the difference was insignificant. Incidence of shivering and interventions for shivering, one hour pain scores and total analgesic required in 24 hours were significantly lower in group D as compared to group R. Conclusions: Ramosetron 0.3 mg was as effective as combination of ramosetron 0.3 mg and dexmedeto-midine 1µ/kg given before anaesthesia in reducing PONV. However, the combination of two drugs was more effective in reducing the incidence of post-operative shivering episodes, severity of pain, and total postoperative analgesic requirement compared to ramosetron alone in patients undergoing gynaecological laparoscopic surgery. |
Keywords: Ramosetron, Dexmedetomidine, Post-operative nausea and vomiting, Shivering, Gynecological laparoscopic surgery.
References
1. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162-184.
2. McCracken G, Houston P, Lefebvre G; Society of Obstetricians and Gynecologists of Canada.Guideline for the management of postoperative nausea and vomiting. J Obstet Gynaecol Can 2008; 30: 600-607, 608-616.
3. Kranke P, Eberhart LH, Roewer N, Tramer MR. Pharma-cological treatment of postoperative shivering a quan-titative systemic review of randomized controlled trials. Anesth Analg. 2002;94:453–60.
4. Eberhart LH, Döderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005; 101: 1849-57.
5. Kazemi-Kjellberg F, Henzi I. Treatment of established postoperative nausea and vomiting: a quantitative systematic review. BMC Anesthesiol. 2001;1:2.
6. Fujii Y, Saitosh Y, Tanaka H, Tooyuka H. Comparison of ramosetron and granisetron for preventing post-operative nausea and vomiting after gynaecological surgery. Anaesth Analg 1999;89:476-9.
7. Kim SI, Kim SC, Baek YH, Ok SY, Kim SH. Comparison of ramosetron with ondensetron for prevention of post-operative nausea and vomiting in patients undergoing gynaecological surgery. Br J Anaesth 2009;103:549-53.
8. Kim MS, Kim DW, Woo SH, Yon JH, Lee S. Effect of ramosetron on shivering during spinal anesthesia. Korean J Anesthesiol 2010; 58: 256-9.
9. Reiring K, Rewerts C, Zieqlqansberger W. Analgesic effects of 5-HT3 receptor antagonists. Scand J Rheumatol Suppl, 2004;119;19-23.
10. Mann C, Boccara G, Pouzeratte Y, Eliet J, Serradel-Le Gal C,Vergnes C, Bichet DG, et al. The relationship among carbon dioxide pneumoperitoneum, vasopressin release and hemodynamicchanges. Anesth Analg 1999;89:278-83.
11. Poonam S Ghodki, Shalini K Thombre, Shalini P Sardesai, and Kalpana D Harnagle. Dexmedetomidine as an anesthetic adjuvant in laparoscopic surgery: An observational study using entropy monitoring. J Anaesthesiol ClinPharmacol.2012; 28: 334–338.
12. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative analgesic agent. Proc( Bayl Univ Med Cent) 2001; 14:13-21
13. Zhong WG, Ge XU, Zhu H, Liang X, Gong HX, et al. Dexmedetomidine for antiemesis in gynaecologic surgery, a metaanalysis for randomized controlled trials. Int J Clin Exp Med 2015;8:14566-14576.
14. Bajwa SS, Gupta S, Kaur J, A, Parmar SS. Reduction in incidence of shivering with perioperative dexmedetomidine: A rando-mized prospective study. J Anaesthesiol Clin Pharmacol 2012;28: 86-91.
15. Orkin F. What do patient want? Preference or immediate post-operative recovery. Anesth Analg 1992; 74S: 225.
16. Collins KM, Docherty PW, Plantevin OM. Postoperative morbidity following gynaecological outpatient laparoscopy: A reappraisal of the service. Anaesthesia 1984;39:819.
17. Nguyen NT, Furdui G, Fleming NW, Lee SJ, Goldman CD et al. Effect of heated and humidified carbon dioxide gas on core temperature and post operative pain. Surg Endos; 2002;16: 1050-4
18. Yang SY, Jun NH, Choi YS, Kim JC, Shim JK, Ha SH, et al. Efficacy of dexamethasone added to ramosetron for preventing postoperative nausea and vomiting in highly susceptible patients following spine surgery. Korean J Anesthesiol 2012; 62: 260-5.
19. Lee MJ, Lee KC, Kim HY, Lee WS, Seo WJ, et al. Comparison of ramosetron plus dexamethasone with ramosetron on postoperative nausea , vomiting , shivering and pain.Korean J Pain 2015;28:39-44.
20. Wang G, Zhang L, Lou S, Chen Y, Cao Y et al. Effect of dexmedetomidine in preventing postoperative side effects of laparoscopic surgery. A meta- analysis of randomized controlled trials and trial sequential analysis. 2016 Medicine 95(10): e 2927.
21. Asl ME, Isazadefar K, Mohammadian A, Khoshbaten M (2011) Ondansetron and meperidine prevent postoperative shivering after general anesthesia.Middle East J Anaesthesiol 21: 67-70
22. Tie HT, Su GZ, He K, Liang SR, Yuan HW, et al. Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials. BMC Anesthesiol 2014; 14: 12.
23. Hwang SM1 Hypothermia, shivering, and dexmedetomidine. Korean J Anesthesiol.2 014; 66: 337-338.
24. Memiş D, Turan A, Karamanlioglu B, Kaya G, Pamukçu Z. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesthesiol 2002; 19: 47-51.
25. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small dose dexmedetomidine infusions. Anesth Analg 2000; 90:699-705.
26. Jaakola ML, Salonen M, Lehtinen R, Scheinin H. The analgesic action of dexmedetomidine – a novel alpha 2 adrenoceptor agonistin healthy volunteers. Pain 1991;46:281-5.
27. Kaya FN, Yavascaoglu B, Turker G, Yildirim A, Gurbet A, Mogol EB, et al. Intravenous dexmedetomidine, but notmidazolam, prolongs bupivacaine spinal anesthesia. Can J Anaesth 2010;57:39‑45.
28. Reddy VS, Shaik NA, Donthu B, Sannala VKR, Jangam V. Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia: A randomized double‑blind study. J Anaesthesiol Clin Pharmacol 2013;29:342-7.