Objective: The aim of this study is to compare the antiemetic effects of intravenous granisetron 40mcg/kg versus 8 mg dexamethasone for prevention of postoperative nausea and vomiting (PONV) in patients undergoing gynaecologic laparoscopic surgeries.

Subject and Methods: In this prospective comparative study,  a total of 64 women recruited for the study who underwent elective abdominal gynaecologic laparoscopic procedures under general anesthesia with endotracheal intubation, 34 patients were assigned to granisetron group (A) and 30 patients were assigned to dexamethasone group (B). Preoperatively all patients were subjected to a thorough medical history, physical examination, laboratory investigations. Postoperatively patients were assessed according to nausea and vomiting score, hemodynamic changes, and the need for rescue antiemetics.

Results: After 6 hours and up to 24 hours postoperatively, 6 (20%) patients experienced nausea in group (B) compared to 2 (5.9%) patients in group (A) and 5 (16.7%) patients experienced vomiting in group (B) compared to only one (2.9%) patient in group (A) which was significant (P= 0.05, 0.046) respectively. Anti-emetics were used in 5(16.7%) patients in group (B) compared to only one (2.9%) patient in group (A) which was statistically significant (p= 0.045).

Conclusion: Dexamethasone is as effective as granisetron in controlling PONV during the first six hours postoperatively, however during rest of the first day granisetron showed more efficient control of PONV than dexamethasone. On the other hand, dexamethasone could be a good second alternative to granisetron particularly for economic basis in patients undergoing laparoscopic gynaecologic operations despite its expected side effects.

Keywords: dexamethasone, laparoscopic surgeries, granisetron, antiemetics.

1. Gan TJ, Meyer TA, Apfel CC, et al. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007; 105: 1615–28.
2. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89: 652–8.
3. Madaj TH, Simpson KH. Comparison of the use of domperidone, droperidol and metoclopramide in the prevention of nausea and vomiting following major gynaecological surgery. British Journal Anesthesia 1986; 58:884-7.
4. Sarkar M, Sarkar A, Dewoolkar L, CharanS. Comparative study of single dose intravenous ondansetron and metoclopromide as premedication for prevention of postoperative nausea and vomiting in obstetrical laparoscopic surgery under general anesthesia. Internet J Anesthesiology 2007; 13: 2.
5. Yao and Artusios’ Anesthesiology problem oriented patient management, 5th edition, New York, Lippincott Williams and Wilkins 2003; 41: 883-88.
6. Kovac AL. prevention and treatment of postoperative nausea and vomiting. Drugs 2000; 59: 213-43.
7. ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and paediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm 1999; 56: 729-64.
8. Koda-kimble MA, Young LY. Nausea and vomiting. In Koda-kimble MA, Young LY, Kradjan WA, Guglielmo BJ, Corelli RL, eds, Applied therapeutics: the clinical use of drugs. 6^th Vancouver, WA: Applied Therapeutics, 1995: 105-1-105-11.
9. Rowbotham DJ. Current management of postoperative nausea and vomiting. British Journal of Anesthesia 1992; 69: 46-59.
10. Watcha MF, White PF. Nausea and vomiting – its etiology, treatment and prevention. Anesthesiology 1992; 77:162-84.
11. Kovac A, McKenzie R, O'Connor T, et al. Prophylactic ondansetron in female outpatients undergoing gynecological surgery: A multicentre dose comparison. European journal of Anesthesia 1992; 6: 37-47.
12. Catlin FI, Grimes WJ. The effect of steroid therapy on recovery from tonsillectomy in children. Archives of Otolaryngology – Head and Neck Surgery 1991; 117: 649–52.
13. Henzi I, Walder B, Tramer M. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesthesia and Analgesia 2000; 90: 186–94.
14. Gan TJ, Meyer TA, Apfel CC., et al Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615–28.
15. Smita S Lele, Hema B Gupta, Sharath Patel, Bharati A. Tendolkar. Comparison of antiemetic activity of palonosetron with granisetron in postoperative nausea and vomiting after laparoscopic gynaecological surgeries. International Journal of Research in Medical Sciences2016; 4:3685-93.
16. Fuji Y, Tanaka H, Toyooka H. Optimal antiemetic dose of granisetron for preventing postoperative nausea and vomiting. Canadian Journal of Anaesthesia 1994;41(9):794-7.
17. Wadaskar A, Swarnkar N , Yadav A . Granisetron has superior control over postoperative nausea and vomiting than ondansetron in gynecological surgeries: a placebo controlled double-blind clinical study. The Internet J of Anesthesiology 2008; 2:1.
18. Wang X,  Zhou Q, Pan D, et al. Dexamethasone versus ondansetron in the prevention of postoperative nausea and  vomiting in patients undergoing laparoscopic surgery: A meta-analysis of randomized controlled trials. BMC Anesthesiology2 015; 15: 118.
19. Carlisle J, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database of Systematic Reviews 2006; 3: CD004125.
20. Fukami Y, Terasaki M, Okamoto Y, et al. Efficacy of preoperative dexamethasone in patients with laparoscopic cholecystec-tomy: a prospective randomized double-blind study. J Hepatobiliary Pancreat Surg. 2009; 16:367-71.
21. Bianchin A, De Luca A, Caminiti A. Postoperative vomiting reduction after laparoscopic cholecystectomy with single dose of dexamethasone. Minerva Anestesiol. 2007; 73:343-6.
22. Feo CV, Sortini D, Ragazzi R, De Palma M, Liboni A. Randomized clinical trial of the effct of preoperative dexamethasone on nausea and vomiting after laparoscopic cholecystectomy. Br J Surg. 2006; 93:295-9.
23. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a random-ized double-blind placebo-controlled trial. Ann Surg. 2003; 238:651-60.
24. Hessami MA, Yari M. Granisetron versus dexamethasone in prophylaxis of nausea and vomiting after laparoscopic cholecys-tectomy. Anesth Pain. 2012; 2:81-4.
25. Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing
    laparoscopic cholecystectomy : A randomized placebo-controlled study. Surg Endosc. 2008; 22:1487-92.
26. Henzi I, Walder B, Tramer M. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesthesia and Analgesia 2000; 90: 186–94.

Mohamed A Youssry MD

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