Metoclopramide plus Dexamethasone to prevent post-operative vomiting

[timmy]

Post-operative vomiting can be distressful to the patients. I usually give metoclopramide to my patients post-op to prevent or treat post-op vomiting. But this article published in BMJ has shown combination of metaclopramide and dexamethasone given  intraoperatively to be effectivre in preventing post-op nausea and vomiting. Below are the abstract:

Objectives To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions.

Design Four-armed, parallel group, double blind, randomised controlled clinical trial.

Setting Four clinics of a university hospital and four district hospitals in Germany.

Participants 3140 patients who received balanced or regional anaesthesia during surgery.

Main outcome measures Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions.

Results Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting (> 12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.

Conclusion The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions.

BMJ  2006;333:324 (12 August), doi:10.1136/bmj.38903.419549.80 (published 21 July 2006)