DOI QR코드

DOI QR Code

Comparison of Ramosetron Plus Dexamethasone with Ramosetron Alone on Postoperative Nausea, Vomiting, Shivering and Pain after Thyroid Surgery

  • Lee, Myeong Jong (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Lee, Kyu Chang (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Kim, Hye Young (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Lee, Won Sang (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Seo, Won Jun (Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine) ;
  • Lee, Cheol (Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine)
  • Received : 2014.10.01
  • Accepted : 2014.12.01
  • Published : 2015.01.01

Abstract

Background: Postoperative nausea and vomiting (PONV), postanesthetic shivering and pain are common postoperative patient complaints that can result in adverse physical and psychological outcomes. Some antiemetics are reported to be effective in the management of postoperative pain and shivering, as well as PONV. We evaluated the efficacy of dexamethasone added to ramosetron on PONV, shivering and pain after thyroid surgery. Methods: One hundred and eight patients scheduled for thyroid surgery were randomly allocated to three different groups: the control group (group C, n = 36), the ramosetron group (group R, n = 36), or the ramosetron plus dexamethasone group (group RD, n = 36). The patients were treated intravenously with 1 and 2 ml of 0.9% NaCl (group C); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 0.9% NaCl (group R); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 5 mg/ml dexamethasone (group RD) immediately after anesthesia. Results: Incidence of nausea and the need for rescue antiemetics, verbal rating scale (VRS) 1 hour pain value, ketorolac consumption, and incidence of shivering were significantly lower in group R and group RD, than in group C (P < 0.05). Moreover, these parameters were significantly lower in group RD than in group R (P < 0.05). Conclusions: Combination of ramosetron and dexamethasone significantly reduced not only the incidence of nausea and need for rescue antiemetics, but also the VRS 1 hour pain value, ketorolac consumption, and the incidence of shivering compared to ramosetron alone in patients undergoing thyroid surgery.

Keywords

References

  1. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693-700. https://doi.org/10.1097/00000542-199909000-00022
  2. Lopez-Olaondo L, Carrascosa F, Pueyo FJ, Monedero P, Busto N, Saez A. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth 1996; 76: 835-40. https://doi.org/10.1093/bja/76.6.835
  3. Yared JP, Starr NJ, Hoffmann-Hogg L, Bashour CA, Insler SR, O'Connor M, et al. Dexamethasone decreases the incidence of shivering after cardiac surgery: a randomized, double-blind, placebo-controlled study. Anesth Analg 1998; 87: 795-9.
  4. Eberhart LH, Doderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005; 101: 1849-57.
  5. Zwischenberger JB, Kirsh MM, Dechert RE, Arnold DK, Bartlett RH. Suppression of shivering decreases oxygen consumption and improves hemodynamic stability during postoperative rewarming. Ann Thorac Surg 1987; 43: 428-31. https://doi.org/10.1016/S0003-4975(10)62823-8
  6. Macintyre PE, Pavlin EG, Dwersteg JF. Effect of meperidine on oxygen consumption, carbon dioxide production, and respiratory gas exchange in postanesthesia shivering. Anesth Analg 1987; 66: 751-5.
  7. Song YK, Lee C. Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery. J Anesth 2013; 27: 29-34. https://doi.org/10.1007/s00540-012-1473-8
  8. Asl ME, Isazadefar K, Mohammadian A, Khoshbaten M. Ondansetron and meperidine prevent postoperative shivering after general anesthesia. Middle East J Anaesthesiol 2011; 21: 67-70.
  9. Iqbal A, Ahmed A, Rudra A, Wankhede RG, Sengupta S, Das T, et al. Prophylactic granisetron vs pethidine for the prevention of postoperative shivering: a randomized control trial. Indian J Anaesth 2009; 53: 330-4.
  10. 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. https://doi.org/10.4097/kjae.2012.62.3.260
  11. Feroci F, Rettori M, Borrelli A, Lenzi E, Ottaviano A, Scatizzi M. Dexamethasone prophylaxis before thyroidectomy to reduce postoperative nausea, pain, and vocal dysfunction: a randomized clinical controlled trial. Head Neck 2011; 33: 840-6. https://doi.org/10.1002/hed.21543
  12. Jakobsson J. Preoperative single-dose intravenous dexamethasone during ambulatory surgery: update around the benefit versus risk. Curr Opin Anaesthesiol 2010; 23: 682-6. https://doi.org/10.1097/ACO.0b013e32833ff302
  13. Jeon Y, Kim H, Kwak KH. Comparison of ramosetron, dexamethasone, and a combination of ramosetron and dexamethasone for the prevention of postoperative nausea and vomiting in Korean women undergoing thyroidectomy: a double-blind, randomized, controlled study. Curr Ther Res Clin Exp 2010; 71: 78-88. https://doi.org/10.1016/j.curtheres.2010.02.002
  14. Jo YY, Lee JW, Shim JK, Lee WK, Choi YS. Ramosetron, dexamethasone, and their combination for the prevention of postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy. Surg Endosc 2012; 26: 2306-11. https://doi.org/10.1007/s00464-012-2180-0
  15. Ryu JH, Chang JE, Kim HR, Hwang JW, Oh AY, Do SH. Ramosetron vs. ramosetron plus dexamethasone for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy: prospective, randomized, and double-blind study. Int J Surg 2013; 11: 183-7. https://doi.org/10.1016/j.ijsu.2012.12.018
  16. Sanchez-Ledesma MJ, Lopez-Olaondo L, Pueyo FJ, Carrascosa F, Ortega A. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg 2002; 95: 1590-5. https://doi.org/10.1097/00000539-200212000-00022
  17. Kim EJ, Ko JS, Kim CS, Lee SM, Choi DH. Combination of antiemetics for the prevention of postoperative nausea and vomiting in high-risk patients. J Korean Med Sci 2007; 22: 878-82. https://doi.org/10.3346/jkms.2007.22.5.878
  18. Heffernan AM, Rowbotham DJ. Postoperative nausea and vomiting--time for balanced antiemesis? Br J Anaesth 2000; 85: 675-7. https://doi.org/10.1093/bja/85.5.675
  19. Habib AS, Gan TJ. Food and drug administration black box warning on the perioperative use of droperidol: a review of the cases. Anesth Analg 2003; 96: 1377-9.
  20. Powell RM, Buggy DJ. Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anesth Analg 2000; 90: 1423-7. https://doi.org/10.1097/00000539-200006000-00032
  21. 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. https://doi.org/10.4097/kjae.2010.58.3.256
  22. Alfonsi P. Postanaesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs 2001; 61: 2193-205. https://doi.org/10.2165/00003495-200161150-00004
  23. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg 2002; 94: 1517-20. https://doi.org/10.1213/00000539-200206000-00026
  24. Memis D, Turan A, Karamanlioglu B, Kaya G, Pamukcu Z. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesthesiol 2002; 19: 47-51. https://doi.org/10.1097/00003643-200201000-00007
  25. Hval K, Thagaard KS, Schlichting E, Raeder J. The prolonged postoperative analgesic effect when dexamethasone is added to a nonsteroidal antiinflammatory drug (rofecoxib) before breast surgery. Anesth Analg 2007; 105: 481-6. https://doi.org/10.1213/01.ane.0000267261.61444.69
  26. Fredrikson M, Hursti T, Furst CJ, Steineck G, Borjeson S, Wikblom M, et al. Nausea in cancer chemotherapy is inversely related to urinary cortisol excretion. Br J Cancer 1992; 65: 779-80. https://doi.org/10.1038/bjc.1992.165
  27. Aapro MS, Plezia PM, Alberts DS, Graham V, Jones SE, Surwit EA, et al. Double-blind crossover study of the antiemetic efficacy of high-dose dexamethasone versus high-dose metoclopramide. J Clin Oncol 1984; 2: 466-71. https://doi.org/10.1200/JCO.1984.2.5.466
  28. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev 2000; 21: 55-89.
  29. Jansen NJ, van Oeveren W, van den Broek L, Oudemansvan Straaten HM, Stoutenbeek CP, Joen MC, et al. Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac Cardiovasc Surg 1991; 102: 515-25.
  30. Sanchez-Rodriguez PE, Fuentes-Orozco C, Gonzalez-Ojeda A. Effect of dexamethasone on postoperative symptoms in patients undergoing elective laparoscopic cholecystectomy: randomized clinical trial. World J Surg 2010; 34: 895-900. https://doi.org/10.1007/s00268-010-0457-9

Cited by

  1. Receptor Antagonists for the Prevention of Perioperative Shivering: A Meta-Analysis vol.57, pp.4, 2017, https://doi.org/10.1002/jcph.829
  2. Smoking May Increase Postoperative Opioid Consumption in Patients Who Underwent Distal Gastrectomy With Gastroduodenostomy for Early Stomach Cancer vol.33, pp.10, 2017, https://doi.org/10.1097/AJP.0000000000000472
  3. Comparison of the Prophylactic Antiemetic Efficacy of Aprepitant Plus Palonosetron Versus Aprepitant Plus Ramosetron in Patients at High Risk for Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy vol.26, pp.5, 2016, https://doi.org/10.1097/SLE.0000000000000316
  4. Effects of remifentanil versus nitrous oxide on postoperative nausea, vomiting, and pain in patients receiving thyroidectomy vol.95, pp.41, 2016, https://doi.org/10.1097/MD.0000000000005135
  5. Dexamethasone suppresses the growth of human non-small cell lung cancer via inducing estrogen sulfotransferase and inactivating estrogen vol.37, pp.6, 2015, https://doi.org/10.1038/aps.2016.39
  6. Impact of drains on nausea and vomiting after thyroid and parathyroid surgery: a randomized controlled trial vol.404, pp.6, 2015, https://doi.org/10.1007/s00423-019-01799-6
  7. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting vol.131, pp.2, 2015, https://doi.org/10.1213/ane.0000000000004833
  8. A modular ROS-responsive platform co-delivered by 10-hydroxycamptothecin and dexamethasone for cancer treatment vol.340, pp.None, 2015, https://doi.org/10.1016/j.jconrel.2021.10.027