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REGIONAL ANESTHESIA AND PAIN MANAGEMENT

Dexamethasone Decreases Epidural Morphine-Related Nausea and Vomiting

Jhi-Joung Wang, MD, DMSc^*,, Shung-Tai Ho, MD^*, Yuan-Hou Liu, MD, Chiu-Ming Ho, MD, Kang Liu, MD^§, and Yuan-Yi Chia, MD^§

*Department of Anesthesiology, and Graduate Institute of Medical Science, National Defense Medical Center; Department of Anesthesiology, Cathay General Hospital, Taipei; and §Department of Anesthesiology, Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan

Address correspondence and reprint requests to Jhi-Joung Wang, MD, DMSc, Department of Anesthesiology, Tri-Service General Hospital/National Defense Medical Center, No 8, Sec. 3, Ting-Chow Rd., Taipei, Taiwan. Address e-mail to painlab{at}tpts5.seed.net.tw

The aim of our study was to compare the antiemetic effect of IV dexamethasone with saline control in preventing epidural morphine-related nausea and vomiting. Eighty patients requiring epidural anesthesia for abdominal total hysterectomy were enrolled in a randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg for relief of postoperative pain. Before the morphine injection, the dexamethasone group (n = 40) received IV dexamethasone 8 mg, whereas the saline group (n = 40) received IV saline. We found that the incidence of postoperative vomiting was 5% in the dexamethasone group and 25% in the saline group (P < 0.05). The total incidence of nausea and vomiting was 16% in the dexamethasone group and 56% in the saline group (P < 0.001). IV dexamethasone 8 mg significantly decreases the incidence of epidural morphine-related nausea and vomiting.

Implications: We evaluated IV dexamethasone versus saline control in preventing epidural morphine-related nausea and vomiting in patients receiving epidural morphine for postoperative pain control. We found that IV dexamethasone significantly decreased the total incidence of nausea and vomiting after epidural morphine. IV dexamethasone may be a valuable treatment for preventing epidural morphine-related nausea and vomiting.

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