Daut, Farah Nasuha Mohd
(2021)
Granisetron vs. granisetron and dexamethasone on the reduction of postoperative nausea and vomiting (PONV) after caesarean section with intrathecal morphine: a randomised controlled trial.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Intrathecal morphine (ITM) has proven to be excellent in reducing postoperative pain.
However, its use is associated with the occurrence of postoperative nausea and vomiting
(PONV). In this study, we wish to compare the efficacy between the combination therapy
of granisetron and dexamethasone versus granisetron alone on the occurrence of
postoperative nausea and vomiting (PONV) in parturients undergoing elective Caesarean
delivery.
Method
This is a prospective double-blinded, randomised controlled trial (RCT) involving 126
parturients of American Society of Anesthesiologist (ASA) physical status I and II
undergoing elective Caesarean deliveries. Subjects were randomly allocated into 2 groups
(n=63), to either receive a combination of 1mg intravenous (IV) granisetron plus 4mg iv
dexamethasone (Group A) or to receive 1mg IV granisetron (Group B). They were
assessed at 1, 4, 8, 12 and 24-hour postoperatively. Episodes of nausea, retching, vomiting
and the requirement of rescue antiemetics at these time intervals were recorded.
Results
There are no statistically significant differences in the occurrence of nausea, retching and
vomiting between both groups at 1, 4, 8, 12 and 24 hours postoperatively, p=0.999.
It was observed that the occurrence of PONV at 1-hour postoperatively was similar
between both groups. At 4-hour postoperatively the occurrence of nausea and retching in
group A was slightly more than in group B (8.8% vs 7%) but the incidence of vomiting.
was similar between both groups (p=0.999). At 8-hour postoperatively, group A recorded
a slightly higher occurrence of retching than group B (3.5% vs 1.8%) but then again, this
is also statistically insignificant (p=0.999). There was an incident of retching in group B,
but there was no episode of PONV seen in patients in group A (1.8% vs 0, p=0.999) at
12-hour post surgery. No episode of PONV were recorded thereafter. It was also found
that the usage of rescue antiemetics were similar in both groups of subjects, p=0.999.
Conclusion
The use of granisetron is comparable with the use of granisetron and dexamethasone in
the prevention of PONV in parturients receiving intrathecal morphine for elective
Caesarean section.
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