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Treatment
with ondansetron and dexamethasone does not improve the quality of recovery in
subjects undergoing lower extremity orthopedic surgery under spinal anesthesia
utilizing intrathecal morphine.
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:
|
|
Ondansetron Group (n=37) |
Dexamethasone Group (n=41) |
Saline Group (n=40) |
|
Pain Scores (NRS) |
5 (3–7) |
0 (0–5) |
2 (0–6) |
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.
Anesthesiology Research and Practice
The Quality of Recovery after Dexamethasone, Ondansetron, or Placebo Administration in Patients Undergoing Lower Limbs Orthopedic Surgery under Spinal Anesthesia Using Intrathecal Morphine. A Randomized Controlled Trial
Eduardo Toshiyuki Moro et al.
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