Prophylactic Antiemetic Therapy with a Combination of Ondansetron and Dexamethasone in Patients Receiving Hydromorphone IV-Patient Controlled Analgesia

다국어 초록 (Multilingual Abstract)

Background: Patient controlled analgesia (PCA) is a safe and effective means of providing postoperative pain relief. However nausea and vomiting are frequent adverse side effects of opioid-based PCA. In this study, the prophylactic effects of ondansetron and/or dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients receiving hydromorphone IV-PCA were compared and the effectiveness of hydromorphone IV-PCA was evaluated.
Methods: A total of 160 patients who received hydromorphone IV-PCA were enrolled in this randomized, double-blind study to receive one of three prophylactic anti-emetic regimens; 1) ondansetron (4 mg), 2) dexamethasone (8 mg), or 3) ondansetron (4 mg) plus dexamethasone (8 mg). Ondansetron was administered at the end of surgery and dexamethasone was administered before the induction of anesthesia. The placebo (saline) was administered to the controls at the same times. The pain intensity and patient satisfaction were evaluated and the incidence of PONV were recorded.
Results: The patient characteristics, duration of anesthesia, and number of risk factors for PONV were similar in the 3 groups. Patients in the three groups reported similar low pain scores and more than half of the patients returned a high satisfaction score (= 8). There were no significant differences in the level of hydromorphone consumption or rescue analgesic use between the three groups. The overall failure rates of PONV prophylaxis during the 24 h observation period were 31.4%, 36.7%, and 11.5% in the ondansetron, dexamethasone, and ondansetron plus dexamethasone groups, respectively.
Conclusions: Hydromorphone IV-PCA is effective in controlling postoperative pain and ondansetron plus dexamethasone combination is significantly better in preventing PONV than ondansetron or dexamethasone alone. (Korean J Anesthesiol 2006; 51: S 11～7)

참고문헌 (Reference)

1 "The study of postoperative nausea and vomiting" 69 : -3, 1992

2 "The efficacy and incidence of side effects in patient controlled analgesia using hydromorphone" 49 : 667-670, 2005

3 "The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery" 84 : 331-336, 1997

4 "Single dose intravenous ondansetron in the prevention of postoperative nausea and vomiting" 49 : -5, 1994

5 "Relative analgesic potencies of morphine and hydromorphone in post-operative pain" 42 : 602-7, 1975

6 "Pediatric patient-controlled analgesia with morphine versus meperidine" 7 : 204-8, 1992

7 "Patient-controlled analgesia:a comparison of intravenous versus subcutaneous hydromorphone" 69 : 428-32, 1988

8 "Patient-controlled analgesia for mucositis pain in children:a three-period crossover study comparing morphine and hydromorphone" 129 : 722-728, 1996

9 "PCE:patient-controlled emesis" 50 : 180-, 1995

10 "Ondansetron reduces postoperative nausea and vomiting after a laparoscopic cholecystectomy" 49 : 365-369, 2005

11 "Intravenous versus epidural administration of hydromorphone.Effects on analgesia and recovery after radical retropubic prostatectomy" 82 : 682-688, 1995

12 "Impact of antiemetic selection on postoperative nausea and vomiting and patient satisfaction" 21 : 540-548, 2001

13 "Hydromorphone:pharmacology and clinical applications in cancer patients" 9 : 84-96, 2001

14 "Hydromorphone analgesia after intravenous bolus administration" 71 : 41-48, 1997

15 "Experience with epidural hydromorphone for post-thoracotomy pain relief" 66 : 1331-3, 1987

16 "Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy:a quantitative systemic review" 88 : 1354-1361, 1999

17 "Effects of prophylactic antiemetic combination of dexamethasone and ondansetron on postoperative nausea and vomiting in high-risk patients" 49 : 751-756, 2005

18 "Droperidol and 5-HT3-receptor antagonists, alone or in combination, for prophylaxis of postoperative nausea and vomiting. A meta-analysis of randomised controlled trials." 44 : 1252-1257, 2000

19 "Dexamethasone for the prevention of postoperative nausea and vomiting:a quantitative systemic review" 90 : 186-194, 2000

20 "Consensus guidelines for managing postoperative nausea and vomiting" 97 : 62 -71, 2003

21 "Comparison of ondansetron versus placebo to prevent postoperative nausea and vomiting in women undergoing ambulatory gynecologic surgery" 78 : 21-8, 1993

22 "Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia" 50 : 1086-1088, 1995

23 "Comparison of different methods of administering droperidol in patient-controlled analgesia in the prevention of postoperative nausea and vomiting" 80 : 81-85, 1995

24 "Comparing the subjective,psychomotor,and physiological effects of intravenous hydromorphone and morphine in healthy volunteers" 152 : 31-39, 2000

25 "Combination therapy for postoperative nausea and vomiting-a more effective prophylaxis?" 9 : 59-71, 2001

26 "Advances in pain research and therapy" Raven Press 129-35, 1986

27 "A multidimensional comparison of morphine and hydromorphone patient-controlled analgesia" 82 : 1043-1048, 1996

28 "A comparison of morphine,meperidine,and oxymorphone as utilized in patient-controlled analgesia following cesarean delivery" 70 : 585-90, 1989

29 "A comparison of dexamethasone,ondansetron,and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery" 97 : 259-263, 2003