Somsundar R G, Shivakumar G, Santhosh M C B, Krishna K
Department of Anaesthesiology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
Anesth Essays Res. 2022 Jan-Mar;16(1):60-64. doi: 10.4103/aer.aer_2_22. Epub 2022 Jun 27.
One of the most troublesome complications after middle-ear surgeries has been postoperative nausea and vomiting (PONV). A notable decrease in PONV has been observed with the use of 5-hydroxytryptamine type 3 receptor antagonists and glucocorticoids.
This study aimed to evaluate the effectiveness of the combination of intravenous methylprednisolone and ondansetron with ramosetron alone in preventing PONV in patients undergoing middle-ear surgeries.
This was a prospective, randomized, double-blind study that comprised sixty patients in the age group of 18-60 years belonging to the American Society of Anesthesiologists (ASA) physical status classification I or II and undergoing middle-ear surgery.
With the help of computer-generated randomization table, sixty patients in the age group of 18-60 years belonging to ASA physical status classification I or II and undergoing middle-ear surgery were randomly allotted to receive a combination of methylprednisolone 40 mg (given at the beginning of surgery) and ondansetron 4 mg (given near the end of surgery) (Group MO, = 30) or ramosetron 0.3 mg (near the end of surgery) (Group R, = 30). In both the groups, the incidence of PONV was studied.
Chi-square test or Fisher's exact test was utilized to analogize the categorical variables. Independent -test was utilized to analogize the continuous variables.
In the first 2 h after the surgery, the difference between the two groups regarding the incidence of PONV was insignificant. Between 2 h and 24 h, the incidence of nausea was lowered significantly in the group MO compared to the group R ( = 0.01). Between 24 h and 48 h, the incidence of nausea was more in group R compared to the combination therapy group, which was statistically significant.
The combination therapy is better than ramosetron alone for the prevention of PONV after middle-ear surgery. Therefore, we advocate a combination of methylprednisolone and ondansetron for prophylaxis for PONV in middle-ear surgeries.
中耳手术后最棘手的并发症之一是术后恶心呕吐（PONV）。使用5-羟色胺3型受体拮抗剂和糖皮质激素后，PONV明显减少。
本研究旨在评估静脉注射甲泼尼龙和昂丹司琼联合使用与单独使用雷莫司琼在预防中耳手术患者PONV方面的有效性。
这是一项前瞻性、随机、双盲研究，纳入了60名年龄在18 - 60岁之间、属于美国麻醉医师协会（ASA）身体状况分级I或II且正在接受中耳手术的患者。
借助计算机生成的随机化表将60名年龄在18 - 60岁之间、属于ASA身体状况分级I或II且正在接受中耳手术的患者随机分配，分别接受40毫克甲泼尼龙（在手术开始时给予）和4毫克昂丹司琼（在手术接近结束时给予）的联合治疗（MO组，n = 30）或0.3毫克雷莫司琼（在手术接近结束时给予）（R组，n = 30）。在两组中，研究PONV的发生率。
采用卡方检验或费舍尔精确检验来分析分类变量。采用独立t检验来分析连续变量。
在手术后的前2小时，两组之间PONV的发生率差异不显著。在2小时至24小时之间，与R组相比，MO组恶心的发生率显著降低（P = 0.01）。在24小时至48小时之间，与联合治疗组相比，R组恶心的发生率更高，具有统计学意义。
联合治疗在预防中耳手术后的PONV方面优于单独使用雷莫司琼。因此，我们提倡在中耳手术中联合使用甲泼尼龙和昂丹司琼来预防PONV。
