Abstract

Objective: To compare the anti-emetic effect of pre-operatively administered combination of dexamethasone and dimenhydrinate versus dimenhydrinate only on post-operative nausea and vomiting in patients undergoing open appendectomy.
Methodology: In this double-blinded randomized parallel group study, 90 patients undergoing open appendectomy were selected. Group I, received a combination of 8mg dexamethasone and 50mg dimenhydrinate pre-operatively and the group II received 50mg dimenhydrinate only. Patients and observing researcher were completely blinded to the treatment protocol given pre-operatively. The pharmacological variables of anesthesia were kept at a near constant level for all the subjects. Nausea and vomiting were assessed at 0-5 hours post-operatively.
Results: After excluding the patients with per-operatively discovered perforated appendix or post-operative histopathology report showing appendix to be non-inflamed, there were 44 patients in CDD (combined dexamethasone dimenhydrinate) group and 44 patients in D (dimenhydrinate only) group. Asymptomatic cases were observed in 45.4% of the CDD group while only 15.9% of the D group had asymptomatic cases at 0-5 hours post-operatively (p=0.006). Regarding nausea, 50% patients from CDD group and 81.8% from D group experienced some degree of post-operative nausea (p=0.002); 22.7% patients from CDD group and 54.5% from D group also experienced 1 or more than 1 episodes of vomiting during this time interval (p=0.002).
Conclusion: Pre-operative administration of a combination of 8mg intravenous dexamethasone and 50mg intravenous dimenhydrinate resulted in statistically significant lower incidence of post-operative nausea and vomiting at 0-5 hours post-operatively in patients undergoing open appendectomy.

Key words: Acute appendicitis, open appendectomy, dexamethasone, dimehydrinate.