Archives of Anesthesiology and Critical Care 2017. 3(1):270-272.

A Clinical Trial to Determine the Preventive Effective Dose of Promethazine on Postoperative Nausea and Vomiting after Laparoscopic Gastric Plication
Farhad Etezadi, Naser Ghiasnejad Omrani, Mohammad Talebpour, Farsad Imani, Reza Shariat Moharari, Pejman Pourfakhr, Mohammad Reza Khajavi

Abstract


Background: Laparoscopic gastric plication (LGP) is a technique in the restrictive category of bariatric procedures that reduces the gastric volume. Nausea and vomiting are the most common complications after this procedure.

The goal of this research is to determine the preventive effective dose of promethazine on postoperative nausea and vomiting (PONV) after laparascopic gastric placation

Methods: After induction of general anesthesia the patients were divided into two groups, the promethazine 50mg group, which was given promethazine 50mg IM plus dexamethasone 8mg IV and the promethazine 25mg group, which was given promethazine 25mg IM plus dexamethasone 4mg IV. The primary endpoints were the incidence and intensity of nausea and vomiting, and severity of abdominal pain score in postoperative periods.

Results: Sixty-four morbid obese patients were enrolled into the study. Promethazine50mg group was found to significantly reduce the incidence of PONV in the first 12hrs compared with the other group, (21.87% vs37.5%, P=0/068). At the same time the intensity of PONV in base of numeric rating scale was lower in promethazine 50mg group compared to another group (2.63±0.85 vs4.65± 1.23, P=0/089). The mean severity of abdominal pain was higher in promethazine 25mg group, thus these patients needed more analgesia in comparison with another group.

Conclusion: In morbidly obese patients undergoing laparoscopic gastric plication, prophylactive administration of dexamethasone8mg and promethazine 50mg was more effective in the first 12 hours after surgery in reducing the incidence of PONV, and severity of abdominal pain.


Keywords


laparoscopic gastric plication; nausea; vomiting; promethazine; dexamethasone; metoclopramide

Full Text:

PDF

References


Darabi S, Talebpour M, Zeinoddini A, Heidari R. Laparoscopic gastric plication versus mini-gastric bypass surgery in the treatment of morbid obesity: a randomized clinical trial. Surg Obes Relat Dis. 2013; 9(6):914-9.

Niazi M, Maleki AR, Talebpour M. Short-term outcomes of laparoscopic gastric plication in morbidly obese patients: importance of postoperative follow-up. Obes Surg. 2013; 23(1):87-92.

Chouillard E, Schoucair N, Alsabah S, Alkandari B, Montana L, Dejonghe B, et al. Laparoscopic Gastric Plication (LGP) as an Alternative to Laparoscopic Sleeve Gastrectomy (LSG) in Patients with Morbid Obesity: A Preliminary, Short-Term, Case-Control Study. Obes Surg. 2016; 26(6):1167-72.

Khajavi MR, Sadr Azodi SH, Mojtahedzadeh M, Derakhshani D. Comparison the effects of single intramuscular dose of haloperidol and metoclopramide and promethazine, in preventing postoperative nausea and vomiting due to intrathecal use of meperidine. Journal of Iranian Society of Anaesthesiology and Intensive Care. 2007; 29 (58): 46-56.

Jokela RM, Ahonen JV, Tallgren MK, Marjakangas PC, Korttila KT. The effective analgesic dose of dexamethasone after laparoscopic hysterectomy. Anesth Analg 2009; 109(2):607-15.

Talebpour M, Motamedi SM, Talebpour A, Vahidi H. Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes. Ann Surg Innov Res. 2012; 22: 6-7.

Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A. 2007; 17(6):793-8.

Chandrakantan A. Glass PS. Multimodal therapies for postoperative nausea and vomiting, and pain. BJA. 2011; 107 (S1):i27-40.

Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus Guidelines for Managing Postoperative Nausea and Vomiting. Anesth Analg. 2003; 97(1):62-71.

Carlisle J, Stevenson C. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006; (3):CD004125.

Smith HS. Combination Opioid Analgesics. Pain Physician. 2008; 11(2):201-14

Strenkoski-Nix LC, Ermer J, DeCleene S, Cevallos W, Mayer PR. Pharmacokinetics of promethazine hydrochloride after administration of rectal suppositories and oral syrup to healthy subjects. Am J Health Syst Pharm. 2000; 57(16):1499-505.

Khalil S, Philbrook L, Rabb M, Wells L, Aves T, Villanueva G, et al. Ondansetron/ Promethazine combination or Promethazine Alone Reduces Nausea and Vomiting After Middle Ear Surgery. J Clin Anesth. 1999; 11(7): 596-600

Habib AS, Reuveni J, Taguchi A, White WD, Gan TJ. A comparison of ondansetron with promethazine for treating postoperative nausea and vomiting in patients who received prophylaxis with ondansetron: a retrospective database analysis. Anesth Analg. 2007;104(3):548-51.

Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, et al. Prevention of postoperative nausea and vomiting after intrathecal morphine for caesarean: a randomized comparison of dexamethasone, droperidol and a combination. Int J Obstet Anesth. 2007; 16(2):122-7.

Allen TK, Jones CA, Habib AS. Dexamethasone for the Prophylaxis of Postoperative Nausea and Vomiting Associated with Neuraxial Morphine Administration: A Systematic Review and Meta-Analysis. Anesth Analg. 2012; 114(4):813-22.

Talebpour M, Khajavi MR. The effect of promethaze/dexamethazone on postoperative nausea and pain after laparoscopic gastric plication: A randomized clinical trial. Obes Surg.2014; 24 (8):1264.233 SPRING ST, NEW YORK, NY 10013 USA: SPRINGER.

Benevides ML, Oliveira SS, de Aguilar-Nascimento JE. The combination of haloperidol, dexamethasone, and ondansetron for prevention of postoperative nausea and vomiting in laparoscopic sleeve gastrectomy: a randomized double-blind trial. Obes Surg. 2013; 23(9):1389-96.


Refbacks

  • There are currently no refbacks.


Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.