Intraperitoneal Versus Intravenous Dexamethasone Effect on Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

ost-operative nausea and vomiting (PONV) are the most frequent side effect after anesthesia occurring in the first 24 post-operative hours post-operatively. Almost 30% of all patients undergoing general anesthesia experience PONV. Since its first introduction in 1985, laparoscopic cholecystectomy (LC) has become the standard of care in patients with symptomatic cholelithiasis and has replaced open cholecystectomy for the management of uncomplicated gallbladder disease because it allows a shorter hospital stay, an earlier return to work and normal activities with less pain associated with the smaller incision. However, PONV are among the most common distressing side effects associated with LC. The incidence of PONV after LC ranges from 40% to 70% according to operative, anesthetic and patient-related risk factors. Untreated PONV increase the risk of post-operative bleeding, wound dehiscence, gastric aspiration, dehydration and electrolyte imbalance. Moreover, they can prolong post-anesthesia care unit (PACU) stay significantly increase the overall health care costs. Prophylaxis against PONV is essential, especially in high risk patients. Dexamethasone is a steroid, showed to have a potent antiemetic activity.

This study included 90 patients who were scheduled for LC surgery, Patients were randomly allocated into two groups: • The intravenous group (IV group) who received 8 mg IV dexamethasone at the end of the procedure, before laparoscopic trocar withdrawal. • The intraperitoneal group (IP group) who received the same dose of dexamethasone intraperitoneally diluted in 20 ml 0.9% saline at the end of the procedure, before laparoscopic trocar withdrawal.

The aim of this study was to compare the efficacy of intraperitoneal versus intravenous administration of dexamethasone in reducing the incidence of PONV after LC surgeries. The primary outcome was the incidence of PONV during the first 24 hours after laparoscopy. The Secondary outcomes were visual analogue scale (VAS) pain scores, total consumption of analgesics during the first 24 hours postoperatively, the need for antiemetic drugs, and the incidence of delayed complications that may accompany medications within the first week postoperatively.