Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2012 Mar;62(3):260-5. doi: 10.4097/kjae.2012.62.3.260. Epub 2012 Mar 21.
Opioid-based patient controlled analgesia (PCA) provides adequate pain control following spinal surgeries at the expense of increased risk of postoperative nausea and vomiting (PONV). We evaluated the efficacy of dexamethasone added to ramosetron, which is a newly developed five-hydroxytryptamine receptor 3 antagonist with a higher receptor affinity and longer action duration compared to its congeners, on preventing PONV in highly susceptible patients receiving opioid-based IV PCA after spinal surgery.
One hundred nonsmoking female patients undergoing spinal surgery were randomly allocated to either a ramosetron group (group R) or a ramosetron plus dexamethasone group (group RD)., Normal saline (1 ml) or 5 mg of dexamethasone was injected before anesthetic induction, while at the end of the surgery, ramosetron (0.3 mg) was administered to all patients and fentanyl-based IV PCA was continued for 48 hrs. The incidence and severity of PONV, pain score and the amount of rescue antiemetics were assessed for 48 hours after surgery.
The number of patients with moderate to severe nausea (20 vs. 10, P = 0.029), and overall incidence of vomiting (13 vs. 5, P = 0.037) were significantly lower in the group RD than in the group R, respectively. Rescue antiemetic was used less in the RD group without significance.
Combination of ramosetron and dexamethasone significantly reduced the incidence of moderate to severe nausea and vomiting compared to ramosetron alone in highly susceptible patients receiving opioid-based IV PCA after surgery.
阿片类药物患者自控镇痛（PCA）在提供充分的术后疼痛控制的同时，增加了术后恶心和呕吐（PONV）的风险。我们评估了在接受阿片类药物 IV PCA 的高敏患者中，地塞米松联合雷莫司琼（一种新型的 5-羟色胺受体 3 拮抗剂，与同类药物相比，受体亲和力更高，作用时间更长）预防 PONV 的效果。
100 例非吸烟女性脊柱手术患者随机分为雷莫司琼组（R 组）或雷莫司琼加地塞米松组（RD 组）。麻醉诱导前分别给予生理盐水（1ml）或地塞米松 5mg，术毕所有患者给予雷莫司琼（0.3mg），并继续使用芬太尼 IV PCA 48 小时。术后 48 小时评估 PONV 的发生率和严重程度、疼痛评分和止吐药的用量。
RD 组中，中度至重度恶心患者（20 例 vs. 10 例，P=0.029）和呕吐总发生率（13 例 vs. 5 例，P=0.037）均显著低于 R 组。RD 组中，止吐药的使用量虽减少，但差异无统计学意义。
与单独使用雷莫司琼相比，在接受阿片类药物 IV PCA 的高敏患者中，地塞米松联合雷莫司琼可显著降低中度至重度恶心和呕吐的发生率。
