RESUMEN
Background and Aims: For prevention of Postoperative nausea vomiting (PONV) in laparoscopic surgery, ramosetron is a selective 5-HT3 receptor antagonist with higher receptor affinity and slow dissociation than ondansetron. We compared these 2 drugs with propofol which has also shown antiemetic properties. The aim was to study ondansetron, ramosetron, and propofol with respect to incidence of PONV, its severity and the need for rescue antiemetic along with the side effects. Prospective, randomized, double blind study. Material and Methods: We compared antiemetic properties of ondansetron (4 mg i.v; n = 40) and ramosetron (0.3 mg i.v; n = 40) with propofol (0.5 mg/kg i.v; n = 40) on 120 ASA I/II patients scheduled for laparoscopic cholecystectomy. The side effects associated with study drugs, time to recovery from anesthesia, readiness for PACU discharge and patient satisfaction was also compared. Qualitative data variables are expressed by using frequency and percentage and quantitative data variables are expressed by using mean and SD. Quantitative data variables were compared using ANOVA test and others were compared by post hoc ANOVA Tukey's test. Results: Incidence of vomiting and need for rescue antiemetic was lowest with Ramosetron and highest in Propofol group. Time to recovery was more in Propofol group which was statistically significant. Readiness for PACU discharge was comparable in all the three groups. Conclusion: Subhypnotic dose of propofol requires more rescue antiemetic than Ondansetron and Ramosetron because of its short duration of action. Between Ondansetron and Ramosetron the latter is more effective in PONV prevention.
RESUMEN
BACKGROUND: Dexmedetomidine a new drug, which is alpha-two agonist, is recommended by manufacturers as an adjuvant in epidural analgesia and anesthesia. AIMS: To study the effects of dexmedetomidine on quality and efficacy of the epidural bupivacaine 0.5% for vaginal hysterectomies, by studying the onset of action, duration of action, highest dermatomal level achieved, degree of motor blockade, intraoperative and postoperative anesthesia and analgesia achieved. SETTING AND DESIGN: Prospective randomized study. MATERIALS AND METHODS: In this study, 60 American Society of Anesthesiologists I and II patients requiring vaginal hysterectomy were enrolled. Patients were randomly divided into two groups - Group I: Control group receiving epidural bupivacaine 0.5% 15-20 ml only. GROUP II: Group receiving of epidural bupivacaine 0.5% 15-20 ml with dexmedetomidine 05 mcg/kg. Following parameters were noted: Time to onset of T10 dermatomal level, maximum sensory level achieved, time for complete motor block, time for two segmental dermatomes regression, regression to S1 dermatome, time for first rescue analgesic and total top ups required during study. STATISTICAL ANALYSIS: Mean and standard deviation was calculated. We used two independent sample t-test to find the P value. Software used STATA 13.0. RESULTS: The demographic profile was comparable between the groups. There was significant difference between two groups (P < 0.001) regarding onset of analgesia to T10 (17.12 ± 2.44 vs. 10.14 ± 2.94), time to achieve complete motor block (27.16 ± 4.52 vs. 22.98 ± 4.78), which was earlier in dexmedetomidine with bupivacaine group. Prolonged postoperative analgesia, less rescue top ups and adequate sedation score was found with dexmedetomidine group. The intraoperative hemodynamic changes were comparable in both the groups. The incidence of dry mouth, shivering and nausea was more with the dexmedetomidine group. CONCLUSION: We conclude that epidural dexmedetomidine 0.5 µg/kg is a good adjuvant providing early onset of sensory and motor block, adequate sedation and prolonged postoperative analgesia with minimal side-effects.