Comparison of Dexamethasone Plus Metoclopramide, with Dexamethasone Alone in The Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Elective Craniotomy

Objective:  To compare the efficacy of combination of dexamethasone plus metoclopramide with dexamethasone alone for control of postoperative nausea and vomiting in patients undergoing elective craniotomy. Study Design:  Double blinded randomized controlled clinical trial. Material and Methods:  One hundred ASA I – II patients listed for elective craniotomy were randomized to two groups of 50 patients each. Group A received dexamethasone 8 mg (2 ml) plus metoclopramide 10 mg (2 ml) pre-pared in two different syringes, and group B received dexamethasone 8 mg (2 ml) and normal saline (2 ml), pre-pared in two separate received syringes just before induction of anaesthesia. Anaesthesia was standardized. All episodes of Postoperative Nausea and Vomiting (PONV) during the first 24 hours postoperatively were evaluated at 3 time periods : 2, 4, and 24 hours. The presence or absence of nausea and vomiting (by simply yes or no) was assessed by research nurses aware of the study but blinded to the group to which the patient belonged.  Results:  The frequency of nausea and vomiting was clinically and statistically lower in dexamethasone plus metoclopramide group as compared to dexamethasone alone p-value 0.032 and 0.028 for nausea and vomiting respectively. Conclusion:  Combination of dexamethasone plus metoclopramide is more effective in preventing postoperative nausea and vomiting than dexamethasone alone when used for prophylaxis of Post-operative Nausea and Vomiting (PONV) before the induction of anaesthesia in patients undergoing elective craniotomy