Abstract:
Postoperative nausea and vomiting (PONV) is a frequent complication of
middle ear surgery. Ondansetron has been shown to be effective for early PONV and
dexamethasone has been shown to be effective for late PONV. Therefore, a combination
of dexamethasone and ondansetron is commonly used for middle ear surgery. This study
was conducted to compare the combination of ondansetron and dexamethasone with
ramosetron for early and late PONV up to 48 h after middle ear surgery. Methods: One
hundred and twenty adults scheduled for middle ear surgery were allocated to receive
either dexamethasone 8 mg and ondansetron 4 mg (n=60) or ramosetron 0.3 mg (n=60).
General anesthesia with inhalation agents was used for all the patients. The incidence
and severity of PONV, administration of rescue antiemetic, and the side effects of the
antiemetic were documented during the first 48 h after surgery. Results: The incidence of
nausea was significantly lower in the dexamethasone and ondansetron group compared
to the ramosetron group between 2 and 24 h. The complete response, which is patients
with no nausea or vomiting, was significantly more in dexamethasone and ondansetron
group compared to ramosetron group between 2 and 24 h and between 24 and 48
h (76% vs. 56%, P=0.02, 93% vs. 81%, P=0.05, respectively). Overall, complete
response was more in dexamethasone and ondansetron group compared to ramosetron
group (71% vs. 40%, P=0.01). Conclusion: The combination of dexamethasone and
ondansetron is superior to ramosetron for prevention of PONV after middle ear surgeries.
