Antiemetic Prophylaxis with Metoclopramide or Metoclopramide and Dexamethasone in high risk surgical patients

Background: Postoperative nausea and vomiting (PONV) remains a significant cause of morbidity among patients undergoing general anaesthesia. Identification of patients at high risk for PONV allows targeting prophylaxis at those who will benefit most from it. This study was conducted in a tertiary hospital with the aim of comparing the efficacy of a combination of dexamethasone and metoclopramide with that of metoclopramide alone for the prophylaxis of PONV in high risk patients.Patients and methods: 100 adult patients, American Society of Anesthesiologists Physical Status Classification I and II, identified to be at a high risk for PONV using the simplified Apfel scoring system were enrolled in this randomised double blinded study. Each group (n=50), received intravenous (i.v) injections of either metoclopramide 10 mg and placebo (group I) or metoclopramide 10 mg and dexamethasone 5mg (groupII) immediately before the induction of anaesthesia. Nausea and vomiting were assessed over a 24 hour period.Results: At the end of the 24 hour post operative period, the incidence of nausea and vomiting was significantly higher in the patients that were administered metoclopramide and placebo (group I ) compared to those who received a combination of metoclopramide and dexamethasone (groupII). Thirty-six (72%) patients experienced PONV in group I compared to three (6%) patients in group II (p<0.001).Conclusion: We demonstrated that intravenous dexamethasone and metoclopramide combination is more effective than metoclopramide alone in the prophylactic management of postoperative nausea and vomiting in patients identified to be at high risk.Key words: Antiemetics, Post operative Nausea and Vomiting, metoclopramide,dexamethasone, Apfel-score