Dexamethasone alone vs in combination with transcutaneous electrical acupoint stimulation or tropisetron for prevention of postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery

• Published in: British journal of anaesthesia : BJA Vol. 115; no. 6; pp. 883 - 889
• Main Authors: Yang, X.-Y., Xiao, J., Chen, Y.-H., Wang, Z.-T., Wang, H.-L., He, D.-H., Zhang, J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-12-2015; Oxford University Press
• Subjects: Acupuncture Points; Adult; antiemetics; Antiemetics - therapeutic use; Combined Modality Therapy; dexamethasone; Dexamethasone - therapeutic use; Drug Therapy, Combination; electric stimulation therapy; Female; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Humans; Indoles - therapeutic use; Laparoscopy - adverse effects; Laparoscopy - methods; Middle Aged; postoperative nausea and vomiting; Postoperative Nausea and Vomiting - prevention & control; serotonin antagonists; Serotonin Antagonists - therapeutic use; Transcutaneous Electric Nerve Stimulation - methods; Tropisetron; Young Adult; acupuncture points; dexamethasone; serotonin antagonists; electric stimulation therapy; antiemetics; postoperative nausea and vomiting; tropisetron
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aev352

Postoperative nausea and vomiting (PONV) is commonly reported after surgery and anaesthesia. We compared the effects of combinations of electrical acupoint stimulation or tropisetron with dexamethasone with the effects of dexamethasone alone, for inhibition of PONV in gynaecological patients undergoing laparoscopic surgery.
We randomized 157 patients undergoing elective gynaecological laparoscopic surgery under general anaesthesia into the following three groups: acupoint stimulation+dexamethasone (Group Acu, n=53), tropisetron+dexamethasone (Group Trp, n=53), and dexamethasone alone (Group Dxm, n=51). The incidence of nausea, vomiting, and need for rescue antiemetics was recorded 2, 6, 24, and 48 h after surgery.
We found significant differences in the incidence of PONV during 24 h after surgery between the combination therapy groups and the dexamethasone-alone group (P=0.021). In the first 24 h, 28% of patients in Group Acu, 26% of patients in Group Trp, and 50% of patients in Group Dxm experienced nausea, vomiting, or both. The incidence of 24 h PONV in Group Acu was significantly lower than that in Group Dxm (P=0.048; odds ratio 0.389; 95% CI 0.170–0.891). The incidence of 24 h PONV in Group Trp was also significantly lower than that in Group Dxm (P=0.042; odds ratio 0.359; 95% CI 0.157–0.819). There was no significant difference between Group Acu and Group Trp (P=0.857). The need for antiemetic rescue medication was similar in the three groups. All groups expressed similar patient satisfaction.
Combined with dexamethasone, electrical acupoint stimulation or tropisetron is more effective in PONV prophylaxis than dexamethasone alone in gynaecological patients undergoing laparoscopic surgery.
NCT 02096835.