Dexamethasone at anesthesia induction helps prevent nausea, vomiting after bowel surgery

Last Updated: 2017-05-01

By Reuters Staff

NEW YORK (Reuters Health) - A dose of dexamethasone at anesthesia induction can help ward off postoperative nausea and vomiting (PONV) in non-diabetic patients undergoing elective bowel surgery, new findings show.

PONV occurs in over 30% of surgical patients, and can slow recovery and delay discharge, Dr. L. Magill of the University of Birmingham in the U.K. and colleagues note in their report in The BMJ, online April 18.

While dexamethasone is one of the drugs recommended for patients at risk of PONV by the Society for Ambulatory Anesthesia, they add, the benefit of the steroid is not clear in bowel surgery patients, “and its use is far from universal.”

In the DREAMS trial, Dr. Magill and colleagues randomized 1,350 adults undergoing open or laparoscopic surgery, including patients with and without malignant pathology, to receive 8 mg IV dexamethasone at anesthesia induction or standard care.

Among the 674 patients who received dexamethasone, 25.5% vomited within 24 hours of surgery, compared to 33.0% of the 676 patients who received standard care. The number needed to treat (NNT) to prevent vomiting was 13 (p=0.003).

Nearly 40% of the dexamethasone group requested additional postoperative antiemetics, compared to 52% of the standard care group, for an NNT of 8 (p<0.001). Reduced use of on-demand antiemetics persisted for 72 hours.

At 24 hours post-surgery, 62.3% of the dexamethasone group had begun eating, compared to 53.1% of the standard care group (risk ratio, 1.17; p<0.001). Adverse event rates were similar in the two groups.

“This strongly supports the use of dexamethasone as an induction antiemetic for patients undergoing bowel surgery,” Dr. Magill and colleagues write.

They conclude: “At present, guidelines on the management and prevention of PONV are perhaps overly complex and so not widely adopted. Our trial of patients undergoing small and large bowel surgery provides a simple solution for a reduction in PONV.”

The study had no commercial funding, and the researchers declared no conflicts of interest.

Dr. Magill was not available for an interview by press time.

SOURCE: http://bit.ly/2pwW8ZK

BMJ 2017.