Comparison of intraperitoneal versus intravenous dexamethasone on postoperative nausea and vomiting after gynecological laparoscopy: a randomized clinical trial.

Background: The aim of the study was to compare the effect of intraperitoneal versus intravenous dexamethasone for the reduction of postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgeries.

Methods: Eighty adult female patients, American Society of Anesthesiologists physical status I-II, scheduled for gynecological laparoscopic surgery were randomized to receive 8 mg dexamethasone intravenously (IV) (n = 40) or intraperitoneally (IP) (n = 40). The primary outcome was the incidence of PONV during the first 24 h following laparoscopy. Secondary outcomes included visual analogue scale (VAS) pain scores, total consumption of rescue analgesic during the first postoperative 24 h, the need for rescue antiemetic drugs and the incidence of pssible complications that may accompany medications.

Results: Eleven women (27.5%) in the IV group had nausea versus only 3 (7.5%) women in the IP group during 24 h post laparoscopy (p = 0.03). However, 5 patients (12.5%) in the IV group experienced vomiting versus only 2 patients (5%) in the IP group (p = 0.42). No statistical differences in the severity of nausea or the need for rescue antiemetics between both groups. IP group had lower rate of side effects versus IV group (7.5% vs. 27.5%, p = 0.03). The most common side effects in the IV dexamethasone group were headache and dizziness. No significant differences between both groups in the mean VAS of pain and total meperidine consumption during the first 24 h postoperatively.

Conclusions: Intraperitoneal dexamethasone in a dose of 8 mg at the end of gynecological laparoscopy reduces the incidence of postoperative nausea.