A prospective randomized double blinded study - Effect of combined paracetamol and dexamethasone on post operative nausea and vomiting.

Post operative nausea and vomiting (PONV) is one of the most

common distressed, with incidence ranging from 12-38%. The

pathophysiology of PONV is multifactorial; multiple pathways,

neurotransmitters, and risk factors are involved. Some of the

contributing factors for PONV include age < 50 years, female

gender, history of previous PONV or motion sickness,

nonsmoking, obesity, surgical- and anesthetic-related factors

like gastric inflation during mask ventilation, use of opioids and

nitrous oxide and/or parental anxiety.

The feelings associated with PONV are unpleasant and

distressful requiring multimodal treatment approaches. Recent

evidence indicated that inadequate prevention or treatment of

PONV potentiates prolonged recovery and hospitalization,

unpleasant hospital experiences, and increased health care

costs. For instance, prolonged vomiting may result in electrolyte

imbalance (hypocalcemia, hypochloremia, and hyponatremic

metabolic alkalosis) and dehydration, Mallory-Weis tears,

esophageal rupture, aspiration, wound dehiscence, increased

intracranial pressure, postoperative bleeding, and airway

obstruction especially in patients undergoing ENT surgery.

The use of antiemetics can reduce the occurrence of PONV

from over 52% to less than 30% in certain populations. To

decrease the incidence of PONV, a number of antiemetics

including antihistamines, butyrophenones, serotonin receptor

antagonists, corticosteroids, and anesthetic agents have been

tried in clinical use. Nevertheless, most of the antiemetics are

associated with undesirable adverse effects, such as sedation,

hypotension, dysphoria, dry mouth, restlessness, and

extrapyramidal symptoms.

Several studies have shown that dexamethasone, a

corticosteroid, is an effective antiemetic for PONV prophylaxis in

various types of surgery and in improving surgical outcomes.

Dexamethasone is an economical and efficacious antiemetic

drug with negligible side effects. Paracetamol is an analgesic or

anti-pyretic which can inhibit the activity of the cyclooxygenase

enzyme, which leads to inhibition of the prostaglandin production, equivalent to the NSAID.

The Primary objective of this study is to prove whether the

combination of paracetamol and dexamethasone is better

dexamethasone alone in preventing PONV. It is to find out if

paracetamol has any role in reducing PONV and can add to the

efficacy of dexamethasone in further reducing PONV.