Efficacy of Prophylactic Dexamethasone on Postoperative Nausea and Vomiting in Laparoscopic Appendicectomy: A Randomized Controlled Trial

Abstract

Background: Dexamethasone has been established as an effective prophylactic antiemetic in various studies done in elective surgery. However, its efficacy in emergency surgery specifically, laparoscopic appendicectomy is not well documented. This study was conducted to compare the efficacy of prophylactic intravenous (IV) dexamethasone 8mg in preventing postoperative nausea and vomiting (PONV) in this surgical population. Methods: A total of 84 participants were recruited for the study in Hospital Universiti Sains Malaysia and were randomly assigned in equal numbers to treatment group with prophylactic IV dexamethasone 8mg or placebo. The outcomes of both groups were taken at three time intervals; first hour, 12^th hour and 24^th hour postoperatively which were proportion of PONV, PONV scores, pain scores and the need for rescue antiemetic. Results: The group receiving dexamethasone had significantly lower proportion of PONV compared to control group in the first hour postoperatively (dexamethasone vs Control; 16.7% vs 42.9%, P = 0.009) and at 24^th hour postoperatively (0% vs 14.3%, P = 0.011). The dexamethasone group also required less rescue antiemetic at the first hour (14.3% vs 35.7%, P = 0.023) and 12^th hour postoperatively (0% vs 11.9%, P = 0.021). No significant differences in pain scores or PONV scores were found in both groups. Conclusion: Prophylactic dexamethasone reduced postoperative nausea and vomiting (PONV) incidence in the first hour and 24 hours post-surgery, decreased the need for rescue antiemetics in the first hour and 12th hour, but did not significantly affect analgesia or PONV severity between groups.