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REGIONAL ANESTHESIA AND PAIN MEDICINE

Dexamethasone for Preventing Nausea and Vomiting Associated with Epidural Morphine: A Dose-Ranging Study

Shung-Tai Ho, MD, MS^*, Jhi-Joung Wang, MD, DMSc^*, Jann-Inn Tzeng, MD^§, Hang-Seng Liu, MD, Luo-Ping Ger, RN, MPH^*, and Wen-Jinn Liaw, MD, DMSc^*

Departments of *Anesthesiology and Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Anesthesiology, Chi-Mei Medical Center, Tainan; and §Department of Anesthesiology, Municipal Women’s and Children’s General Hospital, Kaohsiung, Taiwan

Address correspondence and reprint requests to Shung-Tai Ho, MD, MS, Department of Anesthesiology, National Defense Medical Center, Rm. 8113, No. 161, Sec. 6, Minchuan E Rd., Taipei, Taiwan. Address e-mail to painlab{at}tpts5.seed.net.tw

We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. Two hundred twenty-five women (n = 45 in each of the five groups) undergoing simple abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. When the incision closure was completed, patients received IV dexamethasone, 10 mg, 5 mg, or 2.5 mg; IV droperidol 1.25 mg; or saline 2 mL. All patients received epidural morphine 3 mg for postoperative analgesia. We found that patients who received dexamethasone 5 mg or 10 mg or droperidol 1.25 mg were significantly different from those who received saline alone in the following variables: the total incidence of nausea and vomiting, the incidence of more than four vomiting episodes, the number of patients requiring rescue antiemetics, the total number of patients with no vomiting and/or no antiemetic medication (P < 0.05 to P < 0.01). The differences among dexamethasone 10 mg and 5 mg and droperidol 1.25 mg were not significant. Dexamethasone 2.5 mg was ineffective. In conclusion, because dexamethasone 5 mg was as effective as 10 mg as an antiemetic, we recommend the smaller dose for preventing nausea and vomiting associated with epidural morphine.

Implications: We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. We found that dexamethasone 5 mg was as effective as 10 mg. We recommend the smaller dose for this purpose.

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