Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial

  • Mohanad Y. Al-Radeef Clinical Pharmacy Department, College of Pharmacy, Tikrit University, Iraq
  • Sattar J. Abood Pharmacology Department, College of Pharmacy, Al Farahidi University, Baghdad, Iraq
  • Waleed K. Abdulsahib 2Pharmacology Department, College of Pharmacy, Al Farahidi University, Baghdad, Iraq
  • Salah O. Hamad Surgery Department, Salah Aden General Hospital, Iraq
Keywords: Nausea, Vomiting, Pain, Metoclopramide, Dexamethasone and normal saline


BACKGROUND: Post-operative nausea and vomiting (PONV) and pain are a common complications of adult patients undergoing anesthesia, but the incidence of these complications in patients go through laparoscopic cholecystectomy or open appendectomy is unknown.

AIM: We conduct this study for comparing the effect of dexamethasone administration with normal saline and with metoclopramide for reducing these undesirable effects.

DESIGN: This was a three-armed, parallel-group, double-blind, and randomized controlled clinical trial.

METHODS: Seventy-two patients of both genders underwent elective surgeries (laparoscopic cholecystectomy or open appendectomy), randomly assigned to three groups: A dexamethasone-treated (8 mg) group (Group 1) (n = 24), normal saline-treated (100 ml) group (Group 2) (n = 24), and metoclopramide-treated (10 mg) group (Group 3) (n = 24). All nausea, vomiting, and pain episodes were recorded during 24 h after anesthesia in three time periods: 0–4, 4–12, and 12–24 h post-anesthesia.

Results: Nausea and vomiting grading scale shows no significant difference when compare dexamethasone (Group 1) with normal saline (Group 2), significant difference when compare dexamethasone (Group 1) with metoclopramide (Group 3), and also significant difference when compare normal saline (Group 2) with metoclopramide (Group 3). Group 1 showed a lower pain score (p < 0.01 and p < 0.0001) compared with pain score recorded by patients of Groups 2 and 3, respectively. Besides that, Group 2 also showed a lower pain score (p < 0.0001) compared with pain score recorded by Group 3 patients.

CONCLUSION: Dexamethasone has unimportant effect when compare with normal saline, more effectiveness than metoclopramide in reducing PONV. However, dexamethasone more effective in reducing pain when comparing with normal saline and metoclopramide for patients they underwent laparoscopic cholecystectomy or open appendectomy surgery under general anesthesia.


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Wu M, Yang L, Zeng X, Wang T, Jia A, Zuo Y, et al. Safety and feasibility of early oral hydration in the postanesthesia care unit after laparoscopic cholecystectomy: A prospective, randomized, and controlled study. J Perianesth Nurs. 2019;34(2):425-30. PMid:30340960

Kumar A, Solanki SL, Gangakhedkar GR, Shylasree TS, Sharma KS. Comparison of palonosetron and dexamethasone with ondansetron and dexamethasone for postoperative nausea and vomiting in postchemotherapy ovarian cancer surgeries requiring opioid-based patient-controlled analgesia: A randomised, double-blind, active controlled study. Indian J Anaesth. 2018;62(10):773-9. PMid:30443060

Aubrun F, Ecoffey C, Benhamou D, Jouffroy L, Diemunsch P, Skaare K, et al. Perioperative pain and post-operative nausea and vomiting (PONV) management after day-case surgery: The SFAR-OPERA national study. Anaesth Crit Care Pain Med. 2019;38(3):223-9. PMid:30339892

Horn CC, Wallisch WJ, Homanics GE, Williams JP. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014;722:55-66. PMid:24495419

Chu CC, Hsing CH, Shieh JP, Chien CC, Ho CM, Wang JJ. The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting. Eur J Pharmacol. 2014;722:48-54. PMid:24184695

Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth Essays Res. 2016;10(3):388-96. https://doi. org/10.4103/0259-1162.179310 PMid:27746521

Ali Khan S, McDonagh DL, Gan TJ. Wound complications with dexamethasone for postoperative nausea and vomiting prophylaxis: A moot point? Anesth Analg. 2013;116(5):966-8. PMid:23606467

Sugandarajappa SG, Rashmi NR, Sumitha CS, Chengode S. Comparison of analgesic effect of intra-articular buprenorphine and morphine following arthroscopic surgery of knee. J Evol Med Dent Sci. 2016;5:4175-81. jemds/2016/953

Shoar S, Esmaeili S, Safari S. Pain management after surgery:A brief review. Anesth Pain Med. 2012;1(3):184-6. PMid:24904790

Jafra A, Mitra S. Pain relief after ambulatory surgery: Progress over the last decade. Saudi J Anaesth. 2018;12(4):618-25. PMid:30429746

Kupeli E, Er Dedekarginoglu B, Ulubay G, Oner Eyuboglu F, Haberal M. American society of anesthesiologists classification versus ARISCAT risk index: Predicting pulmonary complications following renal transplant. Exp Clin Transplant. 2017;15(Suppl 1):208-13. mesot2014.p183 PMid:28260470

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS pain), Numeric Rating Scale For Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 (Suppl 11):S240-52. PMid:22588748

Barden A, Phillips M, Hill LM, Fletcher EM, Mas E, Loh PS, et al. Antiemetic doses of dexamethasone and their effects on immune cell populations and plasma mediators of inflammation resolution in healthy volunteers. Prostaglandins Leukot Essent Fatty Acids. 2018;139:31-9. plefa.2018.11.004 PMid:30471772

Tolska HK, Hamunen K, Takala A, Kontinen VK. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. Br J Anaesth. 2019;123(2):e397-e411. https://doi. org/10.1016/j.bja.2019.04.063 PMid:31221427

Emami H, Nikbakhsh N, Nassab BH, Khafri S, Darzi AA. Efficacy of single-dose of dexamethasone in reduction of pain, nausea and vomiting after laparoscopic cholecystectomy-a randomised controlled trial. J Evol Med Dent Sci. 2018;7:3825-9. https://doi. org/10.14260/jemds/2018/858

Fujii Y, Nakayama M. Dexamethasone for the reduction of postoperative nausea and vomiting and analgesic requirements after middle ear surgery in adult Japanese patients. Methods Find Exp Clin Pharmacol. 2009;31(5):337-40. https://doi. org/10.1358/mf.2009.31.5.1380460 PMid:19649341

Cho E, Kim DH, Shin S, Kim SH, Oh YJ, Choi YS. Efficacy of palonosetron-dexamethasone combination versus palonosetron alone for preventing nausea and vomiting related to opioid-based analgesia: A prospective, randomized, double-blind trial. Int J Med Sci. 2018;15(10):961-8. ijms.24230 PMid:30013436

Talebpour M, Ghiasnejad Omrani N, Imani F, Shariat Moharari R, Pourfakhr P, Khajavi MR. Comparison effect of promethazine/ dexamethasone and metoclopramide/dexamethasone on postoperative nausea and vomiting after laparascopic gastric placation: A randomized clinical trial. Anesth Pain Med. 2017;7(4):e57810. PMid:29226110

Ahsan K, Abbas N, Naqvi SM, Murtaza G, Tariq S. Comparison of efficacy of ondansetron and dexamethasone combination and ondansetron alone in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. J Pak Med Assoc. 2014;64(3):242-6. https:// PMid:24864592

Fan ZR, Ma J, Ma XL, Wang Y, Sun L, Wang Y, et al. The efficacy of dexamethasone on pain and recovery after total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(13):e0100. md.0000000000010100 PMid:29595631

Ismail EA, Bakri MH, Abd-Elshafy SK. Dexamethasone alone versus in combination with intra-operative super-hydration for postoperative nausea and vomiting prophylaxis in female patients undergoing laparoscopic cholecystectomy: A randomized clinical trial. Korean J Anesthesiol. 2017;70(5):535-41. https:// PMid:29046773

Wang B, He KH, Jiang MB, Liu C, Min S. Effect of prophylactic dexamethasone on nausea and vomiting after laparoscopic gynecological operation: Meta-analysis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. United Kingdom: Centre for Reviews and Dissemination; 2011.

Goineau S, Guillaume P, Castagné V. Comparison of the effects of clonidine, loperamide and metoclopramide in two models of gastric emptying in the rat. Fundam Clin Pharmacol. 2015;29(1):86-94. PMid:24920467

Isazadehfar K, Entezariasl M, Shahbazzadegan B, Nourani Z, Shafaee Y. The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Med Iran. 2017;55(4):254-8. PMid:28532137

How to Cite
Al-Radeef MY, Abood SJ, Abdulsahib WK, Hamad SO. Comparing the Effect of Dexamethasone, Normal Saline, and Metoclopramide on Prevention of Postoperative Nausea, Vomiting and Pain in Patient Undergoing Laparoscopic Cholecystectomy or Open Appendectomy: A Randomized Clinical Trial. Open Access Maced J Med Sci [Internet]. 2020Mar.25 [cited 2020Oct.23];8(B):139-44. Available from: