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Anesth Analg 2004;98:1066-1071
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000105875.05357.A0

PAIN MEDICINE

A Dose Ranging Study of Dexamethasone for Preventing Patient-Controlled Analgesia-Related Nausea and Vomiting: A Comparison of Droperidol with Saline

Yi Lee, MD, Hsien-Yung Lai, MD, Pei-Chin Lin, MD, Youh-Sun Lin, MD, Shen-Jer Huang, MD, and Ming-Hwang Shyr, MD, PhD

From the Department of Anesthesiology, Buddhist Tzu-Chi Medical Center, Tzu-Chi University School of Medicine, Hualien, Taiwan

Address correspondence to Ming-Hwang Shyr, MD, PhD, Department of Anesthesiology, Buddhist Tzu-chi Medical Center, Tzu-chi University School of Medicine, No. 707, Sec 3, Chung-Yang Road, Hualien, 970, Taiwan. Address reprint requests to Yi Lee, MD, Department of Anesthesiology, Tzu-Chi Medical Center, Tzu-Chi University School of Medicine, no. 707, Sec 3, Chung-Yang Road, Hualien, Taiwan, ROC. Address e-mail to dr.stone{at}msa.hinet.net or drleeyi@sinamail.com.

We designed this study to determine the minimum dose of dexamethasone for preventing nausea and vomiting associated with the use of morphine by patient-controlled analgesia (PCA). Two hundred forty female patients were randomly assigned to receive dexamethasone 2, 4, 8, or 12 mg IV immediately before induction of anesthesia. Droperidol (0.1 mg/mL with morphine 1 mg/mL in PCA pump) and saline were used as controls. The complete response (no postoperative nausea and vomiting and no need for rescue antiemetic for a 24-h postoperative period) rates for dexamethasone 8 mg (72.2%) and 12 mg (78.9%) were significantly more than for saline (42.9%) (P < 0.05). Patients who received dexamethasone 12 or 8 mg also reported higher patient satisfaction than those who received saline (P < 0.05). These results were as effective as adding droperidol 0.1 mg/mL to the morphine PCA without causing drowsiness, restlessness, or arrhythmias. Smaller doses of dexamethasone (4 or 2 mg) were not effective for this propose. The results suggest that dexamethasone 8 mg IV is the minimum effective dose for the reduction of PCA morphine-related nausea and vomiting.

IMPLICATIONS: Morphine administration by patient-controlled analgesia (PCA) is often associated nausea and vomiting. In this double-blind study, the minimum effective dose of dexamethasone for reducing this complication was 8 mg. This was as effective as adding droperidol 0.1 mg/mL to the morphine PCA without causing drowsiness, restlessness or arrhythmias.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.