The Effect of Intranasal Dexamethasone in Preventing Postoperative Nausea and Vomiting Among Children Having Laparoscopic Surgery: A Randomized Controlled Trial

Abstract

Background: After laparoscopic surgery, children often experience postoperative nausea and vomiting (PONV), a common issue that can affect up to 70% of patients if no preventive steps are taken. While dexamethasone administered through an IV has been thoroughly studied for preventing PONV, there’s much less information available about using it nasally. This study set out to explore how effective intranasal dexamethasone is and how long its benefits last in reducing PONV in pediatric patients.
Methods: In our study, we split 116 children aged 2 to 15 years, all preparing for laparoscopic surgery, into two groups after anesthesia started: one group (IND) received intranasal dexamethasone at a dose of 0.2 mg per kg, while the other group (INS) was given normal saline as a placebo. The main focus was on PONV rates over the initial 24 hours postoperatively.
Results: In the first 24 hours, PONV hit 24.1% in the dexamethasone arm compared to 46.6% in saline (odds ratio 0.38, 95% CI from 0.20 to 0.70; p=0.002). The onset of first nausea or vomiting came later, and fewer kids needed backup antiemetics (21% vs. 40%). Post-anesthesia care unit (PACU) time was cut by about 18 minutes on average in the IND group (95% CrI -30 to -7). Parents gave higher marks for satisfaction, with 81% rating 4 or above versus 55% in INS.
Conclusion: Intranasal dexamethasone reduces nausea and vomiting after laparoscopic surgery in children within the first 24 hours. Intranasal dexamethasone administration is a useful option for preventing PONV in children.