Single-dose dexamethasone administered preoperatively reduces nausea and vomiting following middle ear surgery

Objective The objective of this study was to evaluate the efficacy of a preoperative single-dose ofdexamethasone (8 mg) in ameliorating postoperative nausea and vomiting (PONV) after middle ear surgery. Patients and methods Forty patients scheduled for middle ear surgeries were enrolled in this prospective, double-blind, placebo-controlled study. They were randomly divided into two groups.Group A, which was the test group (patients were intravenously administered 2 ml of 8 mg dexamethasone 1 h preoperatively), and group B, which was the placebo group (patients were intravenously administered 2 ml of normal saline 1 h preoperatively). All patients underwent standard GA and tympanoplasty conducted by the same anaesthetic and surgical teams. Number of episodes of PONV were recorded from onset of recovery in the post-operative care unit (PACU) until 24 h postoperatively. Antiemetic requirements and vital data were recorded for 24 h postoperatively.Results There were significant statistical differences between the two groups during the early postoperative period in the PACU and at 2 and 4–6 h postoperatively, with the results being in favour of group A. In the PACU no patient in group A experienced nausea or vomiting as compared with two patients (10%) in group B who experienced nausea and one patient (5%) who experienced vomiting (P= 0.001 and 0.01, respectively). At 2 h postoperatively, one patient (5%) in group A experienced nausea and no patient suffered from vomiting compared with three patients (15%) ingroup B who had nausea and two patients (10%) who experienced vomiting (P = 0.001). At 4–6 h postoperatively, one patient (5%) in group A suffered from nausea and one patient (5%) experienced vomiting, whereas two patients (10%) in group B had nausea and two patients (10%) experienced vomiting (P= 0.01). At 12 h postoperatively, one patient (5%) in both groups experienced nausea and no patient experienced vomiting (P = 0.224). At 24 h postoperatively there were no patients suffering from nausea or vomiting in either group. In group A the total number of episodes of nausea and vomiting were three (15%) and one (5%), respectively, as compared with eight incidences (40%) of nausea and five incidences (25%) of vomiting in group B (P= 0.001). The mean dose of ondansetron (Zofran) used as an antiemetic supplement was 4.6 ± 1.1 mg in group A and 8.0 ±3 mg in group B(P = 0.01). Conclusion Preoperative intravenous administration of single-dose dexamethasone (8 mg) can significantly reduce the incidence of PONV in patients undergoing middle ear surgeries and can therefore be considered a reliable prophylactic antiemetic drug.