Comparison of Metoclopramide and Dexamethasone in Post-Operative Vomiting

Postoperative nausea and vomiting are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the ecacy of dexamethasone and metoclopramide to prevent postoperative vomiting (POV) in patients undergoing abdominal surgeries. Objective: To compare the ecacy of injection metoclopramide with injection dexamethasone for POV after abdominal surgeries. Methods: This Randomized Double-Blind Controlled Trial was conducted in ward 3, Jinnah Postgraduate Medical Centre, Karachi for one year., upon a sample of 98 patients, aged 12 to 60 years and undergoing abdominal surgery (elective and emergency) divided into two groups (Group A: Injection Metoclopramide 10 mg, and Group B: Injection Dexamethasone 8mg), of 49 patients each. The incidence of POV were recorded during the rst 24 h postoperatively. Results: The mean age of the sample stood at 31 (SD ± 03) years, with most of the sample comprising of males (72.45%). Vomiting was noted in both groups, with group a reporting vomiting among 07 individuals and group B reporting vomiting among 09 individuals. There was no statistical difference between the incidences of vomiting in both groups. Conclusion: After careful consideration, it may be concluded that both agents, namely metoclopramide and dexamethasone are ecacious at minimizing the incidence of POV and hence both may be used interchangeably or in conjunction among patients undergoing abdominal surgeries.

proposed to carry signi cant risk of POV [5]. Owing to this multifaceted causation of POV, neither of the present classes of anti-emetics is entirely curative for patients and a single best option continues to elude us. Among the many choices available for prophylaxis, the two most used drugs are a metoclopramide and dexamethasone [6]. Though metoclopramide is an established anti-emetic, the use of dexamethasone for this purpose is relatively new. Individual clinical research has noted dexamethasone to be an effective antiemetic agent capable of lessening the incidence of early PONV following abdominal surgeries [7]. It is also reported that dexamethasone usage is free from any marked adverse effects. Moreover, it may decrease postoperative pain after laparoscopic cholecystectomy [8]. In this modern era of medicine, patients demand to be

M E T H O D S
given the best evidence-based medicine to treat their condition. However, owing to a lack of direct comparative s t u d i e s b e t w e e n t h e t o p t w o d r u g s f o r P O V (metoclopramide and dexamethasone), healthcare professionals are often at loss for ample evidence to choose between either of the two. In this scenario, POV prevention, following abdominal surgeries is a test for the healthcare provider [9,10]. Owing to the discomfort it brings to the patients and the increasing frequency of such surgeries being performed on daycare basis, knowledge regarding the most effective prophylactic therapy is becoming highly desirable for alleviation of undesirable POV symptoms and an early home discharge. The high incidence and much distress associated with POV merits the utmost attention. An ideal prophylactic regimen, if identi ed, can signi cantly decrease the morbidity associated with this condition. The aim of study was to compare the e cacy of injection metoclopramide with injection dexamethasone for POV after abdominal surgeries.
This randomized double-blind controlled trial was conducted in Ward 3, Jinnah Postgraduate Medical Centre, Karachi, from November 2020 to November 2021, upon a sample of 98 patients, aged 12 to 60 years and undergoing abdominal surgery (elective and emergency) divided into two groups (Group A: Injection Metoclopramide 10 mg, and Group B: Injection Dexamethasone 8mg), of 49 patients each. The incidence of POV were recorded during the rst 24 h postoperatively. All consecutive patients presenting to the study setting and meeting the eligibility criteria were allocated to either of the groups (A or B) using computer generated simple randomized numbers. The study medicines were given by slow (thirty seconds) IV injection. Postoperatively, all patients were monitored for POV for 24 hours. POV was checked at thirty minutes and 2, 4, 8 and 24 hours after surgery by the researcher. The intensity of POV was gauged using a visual analog scale ranging from no symptom (0 cm) to maximum intensity symptoms (10 cm). The visual analog scale was categorized into four parts: zero cm for no symptoms; one to three cm for mild symptoms; three to seven cm for moderate symptoms, and seven to ten cm for severe symptoms. Data was analyzed using the IBM SPSS version 21.0 and M.S Excel 2013. Descriptive statistics such as mean ± standard deviation (SD) was used for continuous variables such as age and VAS Score. Numbers and percentages were used to describe the proportion of categorical variables such as sex and the frequency and severity of POV.

R E S U L T S
The mean age of the sample stood at 31 (SD ± 03) years, with most of the sample comprising of males (72.45%). The summary of descriptive statistics is tabulated below in Table 1  The severity of POV is tabulated below in both groups, Table  3.  A common complication encountered by patients following abdominal surgery is POV. The condition, though seemingly non-life threatening, is much distressful and at times, a stronger source of patient dissatisfaction than even postoperative pain [10]. POV may hinder the early discharge of otherwise recovered patients and thus add to burden on the already limited healthcare resources [11]. Having a post-operative incidence as high as 63% following certain abdominal surgeries, (in the absence of pharmacologic prophylaxis [12] there is a dire need to address this condition. Metoclopramide and dexamethasone are two commonly employed drugs known to offer prophylaxis against POV [13]. In this research, the incidence did not exceed 18.38% due to the pharmacologic prophylaxis.

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Research suggests that dexamethasone may offer successful prophylaxis against POV at a dose of 5-8mg. Similarly, there is evidence of metoclopramide too exhibiting successful prophylactic ability against POV at a dose of 4mg [14]. Existing RCTs have fallen short of identifying which among the two pharmacologic agents exhibits a better prophylactic ability and provides more relief to the patients from POV following abdominal surgeries [15,16]. Research with contradicting claims have begun to sur face recently, with some claiming C O N C L U S I O N dexamethasone to be a better prophylactic agent (especially owing to its safety, cost-effectiveness and being free from any reported side effects in addition to offering pain relief) the while the others supporting ondansetron (due to its greater e cacy) [17,20].
After careful consideration, it may be concluded that both agents, namely metoclopramide and dexamethasone are e cacious at minimizing the incidence of POV and hence both may be used interchangeably or in conjunction among patients undergoing abdominal surgeries.