The influence of dexamethasone and ketolgan on postoperative nausea and vomiting and estimation of risk factors in women undergoing gynecologic laparoscopic surgeries

Kęstutis Rimaitis^{1, 2}, Asta Svitojūtė³, Andrius Macas¹

¹Department of Anesthesiology, Kaunas University of Medicine, ²Department of Gynecology and Obstetrics, Kaunas University of Medicine, ³Faculty of Medicine, Kaunas University of Medicine, Lithuania

Key words: gynecologic laparoscopic surgery; nausea; vomiting.

Summary. The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting.

Material and methods. A prospective, double-blind, randomized clinical study was carried out. One hundred fifty-three ASA I–II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery.

Results. The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine-free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-inflammatory drugs (P=0.00002).

Conclusions. Preoperative medication with dexamethasone significantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting.

Correspondence to K. Rimaitis, Department of Gynecology and Obstetrics, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: kestutis.rimaitis@kmuk.lt

Received 1 April 2009, accepted 6 April 2010