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Laparoscopic cholecystectomy (LC) is a gold standard surgical procedure for cholelithiasis and some cases of cholecystitis and gallbladder stone. Although the surgical techniques are improved and have satisfied outcomes, postoperative nausea and vomiting (PONV) is a common and disturbing effect arisen from operation and anesthesia and is often more irritating than patient pain. The prevalence of PONV depends on many factors including anesthesia type, length and type of operation, and patient gender since women develop PONV more than men. Patients with motion sickness are more affected by PONV.
Routine use of antiemetic drugs is not required in all surgeries because according to statistics, 30% of patients develop this effect after surgery.
Patients undergoing laparoscopic cholecystectomy (LC) are more prone to PONV with a reported occurrence of 53-72%, and this increases the length of recovery, the delay in patient discharge, patient dissatisfaction, and hospital costs. The reason for LC-induced PONV is not clear yet, however, some factors are involved such as using isoflurane and fentanyl during operation, peritoneum stretching, increased blood pressure in the peritoneal cavity, and narcotics injection after operation.
Different efforts have been done to reduce the occurrence of PONV, and many antiemetic drugs have been studied. However, given the multifactorial origin of PONV, these medicines are not completely effective in all patients. Meanwhile, dexamethasone is used as an effective antiemetic drug, which mechanism is not understood, but it may act through central inhibition of prostaglandin synthesis, serotonin inhibition in intestine, inhibition of endorphin release, and change in permeability of blood brain barrier to serum proteins (1-3). Various studies have investigated the impact of dexamethasone alone or in combination with other medicines on PONV.
In a double-blinded randomized clinical trial in 2009, Fuji et al. studied the effect of dexamethasone in reducing nausea, vomiting, and the need for analgesics after operation. In this study, 90 patients who were candidate for LC were divided into three groups of dexamethasone 8 mg, dexamethasone 4 mg, and placebo, and were evaluated in terms of nausea, vomiting, and the need for analgesics after operation. Finally, it was concluded that dexamethasone 8 mg is effective in reducing nausea, vomiting, and the need for analgesics after operation in patients undergoing LC.
Sanchez-Rodriguez et al. (2010) investigated the preventive effect of dexamethasone on PONV in a double-blinded randomized clinical trial. They divided 210 patients elected for LC into two groups of 8 mg dexamethasone and placebo. The results showed that the pharmaceutical regimen used was safe with no specific adverse effect and significantly reduced PONV in patients undergoing LC. Intravenous paracetamol or acetaminophen is other drug studied for reducing nausea and vomiting.
Intravenous paracetamol or acetaminophen is widely used as an analgesic and despite its known little anti-inflammatory and anti-pyretic effects, it has sufficient impact on peripheral and central pain systems. It acts through inhibitory mechanism of bradykinin in the peripheral system and through mediators such as NMDA, substance P, and nitric oxide pathway in the central system.
In 2011, Cok et al. studied the effect of paracetamol on PONV. A total of 90 patients of 2 to 14 years old undergoing strabismus surgery were divided into two groups of paracetamol (15 mg/kg) and normal saline and were evaluated in terms of postoperative nausea and vomiting and the need for analgesics. The results showed that paracetamol significantly reduced postoperative nausea and vomiting and the need for analgesics in the first 24 hours.
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