In a recent prospective, randomized, double-blinded, and placebo-controlled analysis, neither ondansetron nor dexamethasone was found to boost the quality of recovery in patients undergoing lower limb orthopedic surgery under spinal anesthesia using intrathecal morphine and receiving either ondansetron, dexamethasone, or placebo.

Intrathecal morphine is extensively utilized to avoid postoperative pain after lower limb orthopedic surgery. However, it can cause undesirable side effects. This study was conducted to analyze dexamethasone or ondansetron effect when compared to placebo to diminish the occurrence of deleterious side effects and, consequently, to enhance the quality of recovery based on the subject’s perspective.

135 orthopedic surgery subjects under spinal anesthesia utilizing bupivacaine and morphine were randomly assigned to IV dexamethasone, ondansetron, or saline groups. Following the morning after surgery, a QoR-40 (quality of recovery questionnaire) was finalized. The incidence of vomiting, pruritus, nausea and urinary retention; use of analgesics; postoperative pain scores, and PACU (postanesthesia care unit) length of stay were also investigated.

There were no major differences reported in the global and dimensional QoR-40 scores following limb surgery. However, following PACU discharge, pain scores were elevated in patients treated with ondansetron in comparison with patients treated with dexamethasone as depicted in the following table:

NRS; Numeric rating scale

Data are presented as median (25%–75% interquartile range)

Further studies are warranted to understand how these medicines affect the quality of longer-term surgical recovery.