The use of dexametazone versus intraperitoneal bupivacaine for the prevention of the nausea and vomiting after laparoscopic cholecystectomy

P.Nicolcescu¹, Liliana Postelnicu², F.Purcaru¹
1) Clinica ATI, Facultatea de Medicină. 2) Clinica ORL, Spitalul Judeţean de Urgenţă, Craiova

Abstract

We compared the efficacy and the safety of using dexamethasone versus bupivacaine in intraperitoneal instillation for preventing nausea and vomiting (PONV) after laparoscopic cholecystectomy. We studied 24 patients (19 females) ASA I and II scheduled for laparoscopic cholecystectomy. The patients were randomly divided using a sealed envelope technique, into two equal groups , A and B. General anesthesia was induced with thiopental (3.5 mg/Kg), fentanyl (0.002 mg/Kg), succinylcholine (1 mg/Kg). Vecuronium (0.1mg/Kg) was used for relaxation and to facilitate mechanical ventilation. Patients were ventilated with oxygen and sevofluran 1.2-1.5%.At the end of the surgical intervention the neuromuscular blockade was not reversed. Patients of Group A received 8 mg of dexamethasone i.v. before induction. At the end of the surgical procedure, the Group B patients received 100 mg of 0.5% bupivacaine (20 ml) in intraperitoneal instilation. Nausea and vomiting were defined using international recommendations. The emesis score, and the pain score (VAS 0-10 points) were determined at one hour interval during the first 24 postoperative hours. Statistical analysis was performed using a two sided Student’s t test and the chi square test (p<0.05 indicated a statistical significance). There was no significant difference regarding the incidence of nausea and vomiting between the groups. Antiemetic treatment (metoclopramid 10 mg i.v.) was required for 2 patients in group A and 2 patients in group B. The number of analgesic doses required to obtain a VAS score <4 points in the first 24 postoperative hours was significantly smaller in group B (25±14.6 mg) in comparison with group A (91±18.7 mg).

Conclusions. The i.v. dexamethasone and intraperitoneal instillated bupivacaine are approximately of equal efficacy for prevention of PONV after laparoscopic chole-cystecomy. Bupivacaine offers a better prevention of the postoperative pain.

Key words: dexametazone, bupivacaine, PONV, laparoscopic cholecystectomy

Dexametazona i.v. versus bupivacaina în instilare intraperitoneală pentru prevenirea stărilor de greaţă şi vomă după colecistectomia laparoscopică

Jurnalul Român de Anestezie Terapie intensivă 2006 Vol.13 Nr.1, 17-22