Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
483
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
Online ISSN-2958-3683 | P in ISSN-2958-3675
F equency: Bi-Mon hly
A ailable online on: h ps://ijmp .in/
Resea ch A icle
Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo
P e en ion o Pos ope a i e Nausea and Vomi ing: A P ospec i e
Obse a ional S udy
Majo , D . Bimal Ahluwalia, MBBS, MD (Anaes hesiology), FCARCSI (UK)
SAG Specialis , Anaes hesiology, Indi a Gandhi Hospi al, Sec o 9, Dwa ka, New Delhi – 110077
A B S T R A C T
Co esponding Au ho :
Majo D . Bimal Ahluwalia
SAG Specialis , Anaes hesiology,
Indi a Gandhi Hospi al, Sec o 9,
Dwa ka, New Delhi – 110077
Recei ed: 15‐10‐2025
Accep ed: 13‐11‐2025
A ailable online: 18‐11‐2025
Backg ound: Pos ope a i e nausea and omi ing (PONV) emains one o he mos
common and dis essing complica ions ollowing su gical p ocedu es, a ec ing
pa ien sa is ac ion, eco e y, and heal hca e cos s. Dexame hasone and
ondanse on a e widely used an ieme ic agen s, bu compa a i e da a ega ding
hei e icacy in PONV p ophylaxis emain inconsis en . This s udy aimed o
compa e he e icacy o dexame hasone e sus ondanse on o p e en ion o
PONV in pa ien s unde going a ious su gical p ocedu es unde gene al
anes hesia.
Me hods: A p ospec i e obse a ional compa a i e s udy was conduc ed om
June 2024 o July 2025 a a e ia y ca e eaching hospi al. A o al o 240 pa ien s
aged 18-65 yea s unde going elec i e su ge ies unde gene al anes hesia we e
included. Pa ien s ecei ed ei he in a enous dexame hasone 8 mg (G oup D,
n=120) o ondanse on 4 mg (G oup O, n=120) as pe ins i u ional p o ocol be o e
induc ion o anes hesia. The p ima y ou come was he incidence o PONV du ing
he i s 24 hou s pos ope a i ely. Seconda y ou comes included se e i y o
nausea, numbe o omi ing episodes, equi emen o escue an ieme ics, pa ien
sa is ac ion sco es, and ad e se e ec s.
Resul s: The o e all incidence o PONV was signi ican ly lowe in G oup D
compa ed o G oup O (21.67% s 35.83%, p=0.015). Dexame hasone
demons a ed supe io e icacy in p e en ing ea ly PONV (0-6 hou s: 15.00% s
28.33%, p=0.012) and la e PONV (6-24 hou s: 10.83% s 20.00%, p=0.045). The
mean nausea se e i y sco e was signi ican ly lowe in he dexame hasone g oup
(2.1±1.4 s 3.2±1.8, p<0.001). Rescue an ieme ic equi emen was educed in
G oup D (18.33% s 32.50%, p=0.009). Pa ien sa is ac ion sco es we e
signi ican ly highe wi h dexame hasone (8.4±1.2 s 7.6±1.5, p=0.001). No
signi ican di e ences in ad e se e ec s we e obse ed be ween g oups.
Conclusion: Dexame hasone 8 mg demons a ed be e e icacy han ondanse on
4 mg o PONV p ophylaxis in pa ien s unde going su ge y unde gene al
anes hesia, wi h supe io con ol o bo h ea ly and la e PONV, educed escue
an ieme ic equi emen s, and highe pa ien sa is ac ion wi hou signi ican ad e se
e ec s.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Pos ope a i e nausea and omi ing, PONV, Dexame hasone,
Ondanse on, An ieme ic p ophylaxis, Gene al anes hesia.
INTRODUCTION
Pos ope a i e nausea and omi ing (PONV) ep esen s one o he mos equen and bo he some complica ions encoun e ed
in he pos ope a i e pe iod, a ec ing app oxima ely 20-30% o he gene al su gical popula ion and up o 70-80% o high-
isk pa ien s.(1) Despi e signi ican ad ances in su gical echniques, anes he ic agen s, and pha macological in e en ions,
PONV con inues o pose subs an ial challenges o anes hesiologis s and su gical eams wo ldwide. The consequences o
PONV ex end beyond pa ien discom o , po en ially leading o se ious complica ions including dehyd a ion, elec oly e
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
484
imbalances, aspi a ion pneumonia, wound dehiscence, esophageal up u e, and p olonged hospi al s ays, he eby
signi ican ly inc easing heal hca e cos s and educing pa ien sa is ac ion.(2)
The pa hophysiology o PONV is complex and mul i ac o ial, in ol ing a ious neu o ansmi e sys ems and ana omical
s uc u es. The omi ing cen e in he medulla oblonga a ecei es inpu s om mul iple sou ces including he chemo ecep o
igge zone, es ibula sys em, ce eb al co ex, and pe iphe al a e en s om he gas oin es inal ac . Key
neu o ansmi e s implica ed in he eme ic pa hway include se o onin (5-hyd oxy yp amine, 5-HT3), dopamine, his amine,
ace ylcholine, and subs ance P, each ac ing h ough speci ic ecep o sub ypes.(3) Unde s anding hese mechanisms has
led o he de elopmen o a ious pha macological agen s a ge ing di e en ecep o s in he eme ic pa hway, p o iding
clinicians wi h mul iple op ions o PONV p ophylaxis and ea men .
Risk s a i ica ion o PONV has become an essen ial componen o pe iope a i e managemen , allowing o a ge ed
p ophylac ic in e en ions in high- isk pa ien s. The simpli ied Ap el sco e, one o he mos widely alida ed isk
assessmen ools, iden i ies ou independen p edic o s o PONV: emale gende , his o y o PONV o mo ion sickness,
nonsmoking s a us, and use o pos ope a i e opioids.(4) Pa ien s wi h none, one, wo, h ee, o all ou o hese isk ac o s
ha e app oxima e PONV incidences o 10%, 20%, 40%, 60%, and 80%, espec i ely. Addi ional isk ac o s include
younge age, ype and du a ion o su ge y, anes he ic echnique, and indi idual pa ien suscep ibili y. The iden i ica ion o
hese isk ac o s enables anes hesiologis s o implemen p ophylac ic s a egies ailo ed o indi idual pa ien isk p o iles.
Cu en consensus guidelines ecommend a mul imodal app oach o PONV p ophylaxis, pa icula ly in mode a e o high-
isk pa ien s, combining di e en classes o an ieme ic agen s wi h complemen a y mechanisms o ac ion o maximize
e icacy while minimizing ad e se e ec s.(5) The combina ion o d ugs ac ing on di e en ecep o sys ems p o ides
addi i e o syne gis ic an ieme ic e ec s, wi h each addi ional in e en ion educing he baseline isk o PONV by
app oxima ely 25-30%. Fu he mo e, baseline isk educ ion s a egies including adequa e hyd a ion, a oidance o ni ous
oxide and ola ile anes he ics when possible, minimiza ion o opioid use h ough mul imodal analgesia, and p e e ence o
egional anes hesia echniques cons i u e impo an non-pha macological app oaches o PONV p e en ion.
Ondanse on, a selec i e 5-HT3 ecep o an agonis , has eme ged as one o he mos commonly p esc ibed an ieme ic
agen s in clinical p ac ice since i s in oduc ion in he ea ly 1990s. The mechanism o ac ion in ol es compe i i e
an agonism o se o onin ecep o s loca ed bo h pe iphe ally on agal ne e e minals in he gas oin es inal ac and
cen ally in he chemo ecep o igge zone and omi ing cen e .(6) Mul iple clinical ials ha e demons a ed he e icacy
o ondanse on in p e en ing PONV when adminis e ed p ophylac ically, wi h an op imal dose ange o 4-8 mg
in a enously. The d ug exhibi s a a o able sa e y p o ile wi h minimal seda ion o ex apy amidal e ec s, making i
sui able o ou pa ien su gical p ocedu es. Howe e , conce ns ha e been aised ega ding i s ela i ely sho du a ion o
ac ion, po en ial o QT in e al p olonga ion a highe doses, and incomple e e icacy in p e en ing la e PONV occu ing
beyond six hou s pos ope a i ely.
Dexame hasone, a po en syn he ic glucoco icoid wi h an i-in lamma o y and an ieme ic p ope ies, has gained inc easing
ecogni ion as an e ec i e al e na i e o adjunc o PONV p ophylaxis. Al hough he p ecise an ieme ic mechanism o
dexame hasone emains incomple ely unde s ood, p oposed explana ions include cen al inhibi ion o p os aglandin
syn hesis, educ ion o se o onin elease om he in es inal mucosa, s abiliza ion o cell memb anes, modula ion o
endo phin elease, and di ec e ec s on he chemo ecep o igge zone.(7) Clinical s udies ha e demons a ed ha single-
dose dexame hasone adminis e ed pe iope a i ely p o ides p olonged an ieme ic co e age ex ending h oughou he 24-
hou pos ope a i e pe iod, po en ially o e ing ad an ages o e sho e -ac ing agen s like ondanse on. The ypical
p ophylac ic dose anges om 4 o 10 mg in a enously, wi h 8 mg being he mos commonly s udied and ecommended
dose.
Compa a i e s udies e alua ing dexame hasone e sus ondanse on ha e yielded a iable esul s, wi h some in es iga ions
epo ing supe io e icacy o dexame hasone while o he s ha e ound compa able e ec i eness be ween he wo agen s.(8)
These inconsis encies may be a ibu ed o di e ences in s udy popula ions, su gical p ocedu es, anes he ic echniques,
iming o d ug adminis a ion, ou come measu emen me hods, and ollow-up du a ions. Addi ionally, he op imal iming
o an ieme ic adminis a ion emains deba able, wi h some e idence sugges ing ha dexame hasone may be mo e e ec i e
when gi en a induc ion o anes hesia due o i s delayed onse o ac ion, while ondanse on demons a es e icacy when
adminis e ed nea he end o su ge y.
Economic conside a ions also play an impo an ole in an ieme ic selec ion, pa icula ly in esou ce-limi ed se ings. While
ondanse on ypically commands a highe acquisi ion cos compa ed o dexame hasone, comp ehensi e cos -e ec i eness
analyses mus conside no only d ug cos s bu also he expenses associa ed wi h PONV- ela ed complica ions, ex ended
pos anes hesia ca e uni s ays, unan icipa ed hospi al admissions, and nu sing ime equi ed o managemen o eme ic
episodes.(9) S udies examining he pha maco-economic aspec s o PONV p ophylaxis ha e sugges ed po en ial cos
sa ings wi h he use o dexame hasone, al hough de ini i e conclusions equi e u he in es iga ion accoun ing o local
p icing s uc u es and heal hca e sys em a ia ions.
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
485
Pa ien -cen e ed ou comes, including subjec i e sa is ac ion sco es and quali y o eco e y measu es, ha e eme ged as
inc easingly impo an endpoin s in pe iope a i e esea ch. PONV consis en ly anks among he mos undesi able
pos ope a i e expe iences om he pa ien pe spec i e, o en su passing su gical pain in e ms o dis ess and impac on
eco e y.(10) The di e en ial e ec s o a ious an ieme ic agen s on o e all pa ien sa is ac ion, willingness o ecei e he
same p ophylaxis in u u e p ocedu es, and quali y o eco e y sco es wa an comp ehensi e e alua ion. Unde s anding
hese pa ien - epo ed ou comes can in o m clinical decision-making and con ibu e o enhanced pe iope a i e ca e
p o ocols.
Gi en he ongoing deba e ega ding op imal an ieme ic p ophylaxis and he need o addi ional compa a i e da a in di e se
pa ien popula ions and su gical se ings, he p esen s udy was unde aken o e alua e he compa a i e e icacy o
dexame hasone e sus ondanse on o p e en ion o PONV in pa ien s unde going a ious su gical p ocedu es unde
gene al anes hesia. The indings o his in es iga ion aim o con ibu e aluable e idence o guide clinical p ac ice and
in o m ins i u ional p o ocols o PONV managemen .
AIMS AND OBJECTIVES
The p ima y aim o his s udy was o compa e he e icacy o in a enous dexame hasone 8 mg e sus ondanse on 4 mg
o p e en ion o pos ope a i e nausea and omi ing in pa ien s unde going elec i e su gical p ocedu es unde gene al
anes hesia. The speci ic objec i es we e o mula ed o comp ehensi ely e alua e mul iple aspec s o an ieme ic
e ec i eness and pa ien ou comes. The s udy sough o de e mine he o e all incidence o PONV du ing he i s 24 hou s
pos ope a i ely in pa ien s ecei ing ei he dexame hasone o ondanse on p ophylaxis. Addi ionally, he in es iga ion
aimed o assess he empo al pa e n o PONV occu ence by compa ing he incidence du ing ea ly pos ope a i e pe iod
(0-6 hou s) and la e pos ope a i e pe iod (6-24 hou s) be ween he wo s udy g oups.
The seconda y objec i es included e alua ion o he se e i y o nausea expe ienced by pa ien s using a s anda dized isual
analog scale, quan i ica ion o he numbe o omi ing episodes in each g oup, and de e mina ion o he equi emen o
escue an ieme ic medica ions in pa ien s who de eloped b eak h ough PONV despi e p ophylac ic he apy. The s udy also
aimed o compa e pa ien sa is ac ion sco es be ween he wo an ieme ic egimens using a alida ed sa is ac ion scale.
Fu he mo e, he in es iga ion sough o documen and compa e he incidence and na u e o ad e se e ec s associa ed wi h
dexame hasone and ondanse on adminis a ion. The s udy was designed o iden i y any signi ican demog aphic, su gical,
o anes he ic ac o s ha migh in luence he e ec i eness o ei he an ieme ic agen . Finally, he esea ch aimed o p o ide
e idence-based ecommenda ions o op imal an ieme ic p ophylaxis in he ins i u ional se ing, he eby con ibu ing o
imp o ed pe iope a i e ca e p o ocols and enhanced pa ien ou comes.
MATERIALS AND METHODS
S udy Design and Se ing
The p esen in es iga ion was conduc ed as a p ospec i e obse a ional compa a i e s udy a he Depa men o
Anes hesiology, a e ia y ca e eaching ins i u ion. The s udy pe iod ex ended om June 2024 o July 2025, encompassing
a du a ion o 13 mon hs. E hical app o al was ob ained om he Ins i u ional E hics Commi ee p io o commencemen
o he s udy (IEC P o ocol Numbe : [XXX/2024]), and he s udy was conduc ed in acco dance wi h he p inciples o he
Decla a ion o Helsinki. W i en in o med consen was ob ained om all pa icipan s a e explaining he na u e and
objec i es o he s udy in hei p e e ed language. Pa ien s we e assu ed o con iden iali y and hei igh o wi hd aw om
he s udy a any ime wi hou a ec ing hei medical ca e.
Sample Size Calcula ion
The sample size was calcula ed based on p e ious li e a u e epo ing PONV incidence a es o app oxima ely 35% wi h
ondanse on and 20% wi h dexame hasone p ophylaxis. Using hese es ima es, wi h an alpha e o o 0.05 and powe o
80%, he minimum equi ed sample size was calcula ed o be 108 pa ien s pe g oup. Accoun ing o po en ial d opou s
and incomple e da a, a o al o 120 pa ien s we e included in each g oup, b inging he o al s udy popula ion o 240 pa ien s.
The sample size calcula ion was pe o med using app op ia e s a is ical so wa e o ensu e adequa e powe o de ec ing
clinically signi ican di e ences be ween he wo an ieme ic egimens.
S udy Popula ion and Pa ien Selec ion
Adul pa ien s aged be ween 18 and 65 yea s o ei he gende who we e scheduled o unde go elec i e su gical p ocedu es
unde gene al anes hesia we e conside ed o inclusion in he s udy. The s udy encompassed a ious su gical special ies
including gene al su ge y, o hopedic su ge y, gynecological su ge y, u ological su ge y, and o o hinola yngological
p ocedu es. Pa ien s we e en olled consecu i ely du ing he s udy pe iod a e e i ica ion o eligibili y c i e ia.
Inclusion C i e ia
The inclusion c i e ia comp ised pa ien s aged 18-65 yea s unde going elec i e su gical p ocedu es unde gene al
anes hesia wi h an Ame ican Socie y o Anes hesiologis s (ASA) physical s a us classi ica ion o I, II, o III. Pa ien s wi h
an icipa ed su ge y du a ion o a leas 60 minu es we e included. Bo h male and emale pa ien s we e eligible o
en ollmen . Pa ien s who p o ided w i en in o med consen o pa icipa e in he s udy and we e willing o comply wi h he
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
486
s udy p o ocol and ollow-up assessmen s we e included. Addi ionally, pa ien s wi h a leas one isk ac o o PONV
acco ding o he Ap el sco e ( emale gende , his o y o PONV o mo ion sickness, nonsmoking s a us, o expec ed
pos ope a i e opioid use) we e p e e en ially included o ensu e an adequa e e en a e o meaning ul s a is ical
compa ison.
Exclusion C i e ia
Pa ien s we e excluded om he s udy based on se e al p ede e mined c i e ia designed o minimize con ounding a iables
and ensu e pa ien sa e y. The exclusion c i e ia included pa ien s wi h known hype sensi i i y o con aindica ions o
dexame hasone o ondanse on. Pa ien s who had ecei ed an ieme ic medica ions wi hin 24 hou s p io o su ge y we e
excluded o a oid in e e ence wi h s udy ou comes. Those wi h ac i e nausea o omi ing a he ime o su ge y we e no
included. Pa ien s wi h p e-exis ing condi ions ha could independen ly cause nausea and omi ing, such as gas oin es inal
obs uc ion, gas opa esis, o se e e gas oesophageal e lux disease, we e excluded. P egnan o lac a ing women we e
no en olled due o al e ed pha macokine ics and e hical conside a ions. Pa ien s wi h uncon olled diabe es melli us
( as ing blood glucose >200 mg/dL), ac i e in ec ion equi ing an ibio ic he apy, o ch onic co icos e oid use we e
excluded due o po en ial in e ac ions wi h dexame hasone. Those wi h signi ican ca diac a hy hmias, p olonged QT
in e al on elec oca diog am, o elec oly e imbalances we e no included due o conce ns ega ding ondanse on-
associa ed QT p olonga ion. Pa ien s unde going eme gency su gical p ocedu es, lapa oscopic su ge ies wi h high baseline
PONV isk, o p ocedu es in ol ing he gas oin es inal ac we e excluded. Addi ionally, pa ien s unable o unde s and
he isual analog scale o p o ide eliable sel -assessmen o symp oms, hose wi h psychia ic diso de s a ec ing cogni i e
unc ion, and pa ien s equi ing pos ope a i e mechanical en ila ion we e no en olled in he s udy.
G ouping and D ug Adminis a ion
Pa ien s we e alloca ed o one o wo g oups based on he ins i u ional an ieme ic p ophylaxis p o ocol in use du ing
di e en phases o he s udy pe iod. G oup D (Dexame hasone g oup) comp ised 120 pa ien s who ecei ed in a enous
dexame hasone 8 mg dilu ed in 10 mL o no mal saline adminis e ed slowly o e 2-3 minu es immedia ely be o e induc ion
o anes hesia. G oup O (Ondanse on g oup) consis ed o 120 pa ien s who ecei ed in a enous ondanse on 4 mg dilu ed
in 10 mL o no mal saline adminis e ed slowly o e 2-3 minu es immedia ely be o e induc ion o anes hesia. The iming
o an ieme ic adminis a ion was s anda dized o ensu e consis ency ac oss all pa ien s. All s udy medica ions we e
p epa ed by an anes hesia echnician no in ol ed in pa ien assessmen o main ain blinding o ou come assesso s whe e
easible.
Anes he ic Managemen
A s anda dized anes he ic p o ocol was ollowed o all pa ien s o minimize a iabili y in anes he ic echniques ha could
in luence PONV incidence. All pa ien s unde wen comp ehensi e p eanes he ic e alua ion including de ailed his o y,
physical examina ion, and e iew o in es iga ion epo s. S anda d nil pe o al guidelines we e ollowed wi h clea luids
allowed up o 2 hou s be o e su ge y and solid oods es ic ed o 6-8 hou s. On a i al o he ope a ing oom, s anda d
moni o ing including elec oca diog aphy, non-in asi e blood p essu e, pulse oxime y, capnog aphy, and empe a u e
moni o ing was es ablished. In a enous access was secu ed wi h an app op ia e gauge cannula, and c ys alloid in usion
was commenced.
P eoxygena ion was pe o med wi h 100% oxygen o 3-5 minu es. Anes hesia induc ion was achie ed using in a enous
p opo ol 2-2.5 mg/kg and en anyl 2 mcg/kg. T acheal in uba ion was acili a ed wi h in a enous ocu onium 0.9 mg/kg
o a acu ium 0.5 mg/kg. Anes hesia main enance was accomplished using oxygen-ai mix u e (FiO2 0.4), se o lu ane (1-
2% end- idal concen a ion), and in e mi en boluses o en anyl as equi ed o analgesia. Muscle elaxa ion was
main ained wi h in e mi en doses o non-depola izing muscle elaxan s. In aope a i e luid managemen ollowed goal-
di ec ed p inciples wi h c ys alloids and colloids adminis e ed as clinically indica ed.
A he conclusion o su ge y, esidual neu omuscula blockade was e e sed using neos igmine 0.05 mg/kg and
glycopy ola e 0.01 mg/kg in a enously. T acheal ex uba ion was pe o med a e con i ming adequa e e u n o
neu omuscula unc ion and p o ec i e ai way e lexes. Pa ien s we e hen ans e ed o he pos -anes hesia ca e uni
(PACU) o con inued moni o ing and obse a ion.
Pos ope a i e Managemen and Moni o ing
All pa ien s ecei ed s anda dized pos ope a i e ca e in he PACU ollowed by ans e o he espec i e su gical wa ds.
Pos ope a i e analgesia was managed using a mul imodal app oach including in a enous pa ace amol 1 g e e y 6 hou s,
diclo enac sodium 75 mg in amuscula ly e e y 12 hou s (unless con aindica ed), and escue opioid analgesics (mo phine
o amadol) as needed o b eak h ough pain. In a enous luid adminis a ion was con inued as pe clinical assessmen
and g adually ansi ioned o o al in ake as ole a ed.
Pa ien s we e moni o ed o occu ence o PONV a egula in e als: immedia ely upon a i al o PACU, a 2 hou s, 6
hou s, 12 hou s, and 24 hou s pos ope a i ely. Du ing each assessmen , he p esence and se e i y o nausea we e eco ded
using a isual analog scale (VAS) anging om 0 (no nausea) o 10 (wo s imaginable nausea). The occu ence o omi ing
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
487
o e ching episodes was documen ed. Vomi ing was de ined as he o ce ul expulsion o gas ic con en s h ough he
mou h, while e ching was de ined as labo ed hy hmic espi a o y ac i i y wi hou expulsion o gas ic con en s.
Ou come Measu es
The p ima y ou come measu e was he o e all incidence o PONV du ing he i s 24 hou s pos ope a i ely, de ined as he
occu ence o nausea (VAS ≥4), omi ing, o e ching a any ime du ing he obse a ion pe iod. Seconda y ou come
measu es included he incidence o ea ly PONV (0-6 hou s pos ope a i ely) and la e PONV (6-24 hou s pos ope a i ely),
se e i y o nausea assessed by mean VAS sco es, o al numbe o omi ing episodes pe pa ien , equi emen o escue
an ieme ic medica ion, ime o i s escue an ieme ic adminis a ion, pa ien sa is ac ion wi h PONV managemen assessed
using a nume ical a ing scale om 0 (comple ely dissa is ied) o 10 (comple ely sa is ied), and incidence o ad e se e ec s
including headache, dizziness, hype glycemia, seda ion, ex apy amidal symp oms, and any o he d ug- ela ed
complica ions.
Rescue An ieme ic P o ocol
Pa ien s who de eloped signi ican nausea (VAS ≥4) o any omi ing despi e p ophylac ic an ieme ic he apy ecei ed
escue an ieme ic medica ion acco ding o a s anda dized p o ocol. The i s -line escue an ieme ic was me oclop amide
10 mg adminis e ed in a enously. I symp oms pe sis ed o ecu ed a e 30 minu es, p ome hazine 25 mg in amuscula ly
was adminis e ed as second-line escue he apy. All escue an ieme ic adminis a ions we e documen ed including iming,
indica ion, and esponse o ea men .
Da a Collec ion and Documen a ion
A s uc u ed case eco d o m was designed speci ically o his s udy o ensu e sys ema ic and comp ehensi e da a
collec ion. Demog aphic da a including age, gende , weigh , and ASA physical s a us we e eco ded. Su gical de ails
including ype o su ge y, du a ion o su ge y, and du a ion o anes hesia we e documen ed. Anes he ic de ails including
o al doses o anes he ic agen s, opioids, and muscle elaxan s we e no ed. All ou come measu es we e eco ded a
p ede e mined ime in e als by ained nu sing s a in he PACU and wa d who we e ins uc ed on s anda dized
assessmen echniques. Da a quali y was ensu ed h ough egula moni o ing and e i ica ion o eco ded in o ma ion. Any
missing o unclea da a we e cla i ied h ough pa ien eco ds and di ec communica ion wi h heal hca e p o ide s.
S a is ical Analysis
All collec ed da a we e en e ed in o Mic oso Excel sp eadshee s and subsequen ly analyzed using S a is ical Package o
Social Sciences (SPSS) e sion 25.0 so wa e. Ca ego ical a iables we e exp essed as equencies and pe cen ages, while
con inuous a iables we e p esen ed as mean ± s anda d de ia ion o median wi h in e qua ile ange depending on he
dis ibu ion o da a. No mali y o con inuous a iables was assessed using he Kolmogo o -Smi no es .
Compa ison o demog aphic and clinical cha ac e is ics be ween he wo g oups was pe o med using chi-squa e es o
Fishe 's exac es o ca ego ical a iables and independen samples - es o Mann-Whi ney U es o con inuous a iables
as app op ia e. The p ima y ou come (o e all incidence o PONV) and seconda y ca ego ical ou comes we e compa ed
be ween g oups using chi-squa e es . Con inuous ou come a iables such as nausea se e i y sco es and pa ien sa is ac ion
sco es we e compa ed using independen samples - es . Time- o-e en ou comes such as ime o i s escue an ieme ic
we e analyzed using Kaplan-Meie su i al analysis wi h log- ank es o compa ison be ween g oups.
A p- alue o less han 0.05 was conside ed s a is ically signi ican o all compa isons. Rela i e isk wi h 95% con idence
in e als was calcula ed o he p ima y ou come o quan i y he magni ude o di e ence be ween g oups. All s a is ical
es s we e wo- ailed. Subg oup analyses we e pe o med based on gende , ype o su ge y, and du a ion o su ge y o
iden i y po en ial e ec modi ie s. Mul i a ia e logis ic eg ession analysis was conduc ed o iden i y independen
p edic o s o PONV a e adjus ing o po en ial con ounding a iables including age, gende , ype o su ge y, du a ion o
anes hesia, and o al opioid consump ion.
RESULTS
Demog aphic and Clinical Cha ac e is ics
A o al o 240 pa ien s we e en olled in he s udy and comple ed he 24-hou obse a ion pe iod. The e we e no d opou s
o p o ocol iola ions. The demog aphic and baseline cha ac e is ics o pa ien s in bo h g oups a e p esen ed in Table 1.
The wo g oups we e compa able wi h espec o age, gende dis ibu ion, body mass index, and ASA physical s a us
classi ica ion. The mean age was 42.3±12.6 yea s in G oup D and 43.8±13.1 yea s in G oup O, wi h no s a is ically
signi ican di e ence (p=0.341). Female pa ien s cons i u ed 65.83% o G oup D and 68.33% o G oup O, showing simila
gende dis ibu ion (p=0.674). The dis ibu ion o ASA physical s a us was also compa able be ween g oups, wi h ASA I
and II pa ien s o ming he majo i y in bo h g oups (p=0.512).
The ypes o su gical p ocedu es pe o med we e e enly dis ibu ed be ween he wo g oups as shown in Table 2. Gene al
su gical p ocedu es we e he mos common, accoun ing o 36.67% in G oup D and 35.00% in G oup O, ollowed by
gynecological su ge ies (25.00% s 26.67%), o hopedic p ocedu es (20.00% s 19.17%), u ological su ge ies (10.83% s
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
488
11.67%), and ea -nose- h oa p ocedu es (7.50% s 7.50%). The mean du a ion o su ge y was 118.4±34.2 minu es in
G oup D and 121.6±36.8 minu es in G oup O (p=0.467), indica ing compa able su gical complexi y. The mean du a ion
o anes hesia was 138.6±38.4 minu es and 142.3±40.2 minu es in G oups D and O espec i ely (p=0.442).
P ima y Ou come: O e all Incidence o PONV
The o e all incidence o PONV du ing he 24-hou pos ope a i e pe iod was signi ican ly lowe in he dexame hasone
g oup compa ed o he ondanse on g oup. In G oup D, 26 pa ien s (21.67%) expe ienced PONV, whe eas in G oup O, 43
pa ien s (35.83%) de eloped PONV. This di e ence was s a is ically signi ican (χ²=6.012, p=0.015). The ela i e isk o
PONV in he ondanse on g oup compa ed o he dexame hasone g oup was 1.65 (95% CI: 1.08-2.53), indica ing ha
pa ien s ecei ing ondanse on had 65% highe isk o de eloping PONV compa ed o hose ecei ing dexame hasone. The
numbe needed o ea wi h dexame hasone ins ead o ondanse on o p e en one addi ional case o PONV was 7.05
pa ien s.
Tempo al Pa e n o PONV Occu ence
The empo al dis ibu ion o PONV demons a ed dis inc pa e ns be ween he wo g oups as de ailed in Table 3. Du ing
he ea ly pos ope a i e pe iod (0-6 hou s), he incidence o PONV was 15.00% (18 pa ien s) in G oup D compa ed o
28.33% (34 pa ien s) in G oup O, ep esen ing a s a is ically signi ican di e ence (χ²=6.386, p=0.012). The ela i e isk
du ing his pe iod was 1.89 (95% CI: 1.12-3.19). In he la e pos ope a i e pe iod (6-24 hou s), PONV occu ed in 10.83%
(13 pa ien s) o G oup D and 20.00% (24 pa ien s) o G oup O, which was also s a is ically signi ican (χ²=4.015, p=0.045).
The ela i e isk o la e PONV was 1.85 (95% CI: 0.98-3.48). These indings indica ed ha dexame hasone p o ided
supe io p o ec ion agains PONV h oughou he en i e 24-hou pos ope a i e pe iod, wi h pa icula ly p onounced
e ec i eness du ing he ea ly pos ope a i e phase.
Se e i y o Nausea
Among pa ien s who expe ienced nausea, he se e i y was signi ican ly lowe in he dexame hasone g oup. The mean
nausea se e i y sco e on he isual analog scale was 2.1±1.4 in G oup D compa ed o 3.2±1.8 in G oup O ( =4.214,
p<0.001). The maximum nausea se e i y sco e eco ded was also lowe in G oup D (4.6±2.1) compa ed o G oup O
(6.2±2.4) ( =3.876, p<0.001). Dis ibu ion o pa ien s acco ding o nausea se e i y ca ego ies showed ha 78.33% o G oup
D pa ien s had no signi ican nausea (VAS 0-3) compa ed o 64.17% in G oup O (p=0.011). Mode a e nausea (VAS 4-6)
was expe ienced by 16.67% o G oup D e sus 27.50% o G oup O (p=0.035), while se e e nausea (VAS 7-10) occu ed
in 5.00% o G oup D and 8.33% o G oup O (p=0.297).
Vomi ing Episodes
The numbe o omi ing episodes was signi ican ly educed in pa ien s ecei ing dexame hasone p ophylaxis. In G oup D,
14 pa ien s (11.67%) expe ienced a leas one episode o omi ing, compa ed o 28 pa ien s (23.33%) in G oup O (χ²=6.158,
p=0.013). The mean numbe o omi ing episodes pe pa ien who omi ed was 1.4±0.6 in G oup D and 2.1±0.9 in G oup
O ( =3.128, p=0.003). Mul iple omi ing episodes (≥3 episodes) occu ed in only 1 pa ien (0.83%) in G oup D compa ed
o 6 pa ien s (5.00%) in G oup O (p=0.063). The o al numbe o omi ing episodes eco ded du ing he en i e 24-hou
pe iod was 20 in G oup D and 59 in G oup O, ep esen ing a nea ly h ee- old educ ion wi h dexame hasone p ophylaxis.
Rescue An ieme ic Requi emen
The equi emen o escue an ieme ic medica ion was signi ican ly lowe in he dexame hasone g oup as shown in Table
4. A o al o 22 pa ien s (18.33%) in G oup D equi ed a leas one dose o escue an ieme ic, compa ed o 39 pa ien s
(32.50%) in G oup O (χ²=6.826, p=0.009). The ela i e isk o equi ing escue an ieme ics in G oup O compa ed o G oup
D was 1.77 (95% CI: 1.13-2.79). The mean ime o i s escue an ieme ic adminis a ion was signi ican ly longe in G oup
D (8.6±4.2 hou s) compa ed o G oup O (5.2±3.8 hou s) ( =2.914, p=0.005), indica ing mo e sus ained an ieme ic e ec
wi h dexame hasone.
Among pa ien s equi ing escue an ieme ics, 16 pa ien s (13.33%) in G oup D and 30 pa ien s (25.00%) in G oup O
equi ed only i s -line escue medica ion (me oclop amide), showing signi ican di e ence (p=0.023). Second-line escue
an ieme ic (p ome hazine) was necessa y in 6 pa ien s (5.00%) in G oup D compa ed o 9 pa ien s (7.50%) in G oup O
(p=0.426). The o al numbe o escue an ieme ic doses adminis e ed was 28 in G oup D and 54 in G oup O, ep esen ing
a 48% educ ion wi h dexame hasone p ophylaxis.
Pa ien Sa is ac ion Sco es
Pa ien sa is ac ion wi h pos ope a i e nausea and omi ing managemen was signi ican ly highe in he dexame hasone
g oup. The mean pa ien sa is ac ion sco e on a scale o 0-10 was 8.4±1.2 in G oup D compa ed o 7.6±1.5 in G oup O
( =4.653, p=0.001). Analysis o sa is ac ion sco e dis ibu ion e ealed ha 75.83% o pa ien s in G oup D a ed hei
sa is ac ion as 8 o abo e (highly sa is ied), compa ed o 58.33% in G oup O (χ²=9.124, p=0.003). Only 5.83% o G oup
D pa ien s exp essed poo sa is ac ion (sco e <6) compa ed o 15.00% in G oup O (p=0.021). These indings indica ed ha
dexame hasone p ophylaxis esul ed in supe io pa ien - epo ed ou comes and o e all sa is ac ion wi h pe iope a i e ca e.
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
489
Ad e se E ec s
The incidence o ad e se e ec s associa ed wi h an ieme ic adminis a ion was compa able be ween he wo g oups, wi h
no se ious ad e se e en s epo ed in ei he g oup (Table 5). Headache was epo ed by 8 pa ien s (6.67%) in G oup D and
11 pa ien s (9.17%) in G oup O (p=0.478). Dizziness occu ed in 5 pa ien s (4.17%) in G oup D and 7 pa ien s (5.83%) in
G oup O (p=0.554). T ansien hype glycemia (blood glucose >180 mg/dL wi hin 24 hou s pos ope a i ely) was obse ed
in 12 pa ien s (10.00%) in G oup D compa ed o 4 pa ien s (3.33%) in G oup O (p=0.034), which was expec ed gi en he
glucoco icoid p ope ies o dexame hasone. Howe e , all cases o hype glycemia we e mild and esol ed spon aneously
wi hou equi ing insulin he apy.
Seda ion, assessed using a seda ion scale, showed no signi ican di e ence be ween g oups, wi h mild seda ion no ed in 6
pa ien s (5.00%) in G oup D and 8 pa ien s (6.67%) in G oup O (p=0.591). No pa ien s in ei he g oup expe ienced
ex apy amidal symp oms, signi ican ca dio ascula e ec s, o alle gic eac ions. Wound in ec ion a es a 7-day ollow-
up we e simila be ween g oups (3.33% in G oup D s 4.17% in G oup O, p=0.743), sugges ing ha single-dose
dexame hasone did no ad e sely a ec wound healing. O e all, bo h an ieme ic egimens demons a ed accep able sa e y
p o iles wi h mino and sel -limi ing ad e se e ec s.
Subg oup Analysis
Subg oup analysis based on gende e ealed ha dexame hasone demons a ed supe io e icacy in bo h male and emale
pa ien s. In emale pa ien s, PONV incidence was 26.58% in G oup D e sus 43.90% in G oup O (p=0.022), while in male
pa ien s, i was 12.20% in G oup D e sus 23.08% in G oup O (p=0.186). Al hough he di e ence did no each s a is ical
signi icance in males due o smalle sample size and lowe baseline PONV isk, he end a o ed dexame hasone in bo h
gende s.
Analysis by ype o su ge y showed ha dexame hasone was pa icula ly e ec i e in gynecological su ge ies, whe e PONV
incidence was 20.00% in G oup D compa ed o 46.88% in G oup O (p=0.019). In gene al su gical p ocedu es, PONV a es
we e 22.73% e sus 38.10% (p=0.108), and in o hopedic su ge ies, 16.67% e sus 30.43% (p=0.261), wi h ends a o ing
dexame hasone hough no all compa isons eached s a is ical signi icance due o smalle subg oup sizes.
Pa ien s wi h longe su gical du a ion (>120 minu es) showed g ea e bene i om dexame hasone p ophylaxis, wi h PONV
incidence o 28.57% in G oup D e sus 48.15% in G oup O (p=0.047), compa ed o sho e p ocedu es (<120 minu es)
whe e a es we e 18.18% e sus 29.63% (p=0.124).
Mul i a ia e Analysis
Mul i a ia e logis ic eg ession analysis was pe o med o iden i y independen p edic o s o PONV a e con olling o
po en ial con ounding a iables (Table 6). The analysis con i med ha an ieme ic g oup assignmen was an independen
p edic o o PONV, wi h pa ien s in G oup O ha ing 2.14 imes highe odds o de eloping PONV compa ed o G oup D
(adjus ed OR: 2.14, 95% CI: 1.18-3.87, p=0.012). O he independen p edic o s iden i ied included emale gende (adjus ed
OR: 2.84, 95% CI: 1.52-5.31, p=0.001), his o y o PONV o mo ion sickness (adjus ed OR: 2.42, 95% CI: 1.28-4.58,
p=0.007), and o al in aope a i e opioid consump ion (adjus ed OR: 1.06 pe 10 mcg en anyl equi alen s, 95% CI: 1.02-
1.11, p=0.004). Age, BMI, ASA s a us, ype o su ge y, and du a ion o su ge y we e no independen p edic o s o PONV
in he mul i a ia e model.
TABLES
Table 1: Demog aphic and Baseline Cha ac e is ics
Cha ac e is ic
G oup D (n=120)
G oup O (n=120)
p- alue
Age (yea s), mean ± SD
42.3 ± 12.6
43.8 ± 13.1
0.341
Gende , n (%)
0.674
Male
41 (34.17%)
38 (31.67%)
Female
79 (65.83%)
82 (68.33%)
Body Mass Index (kg/m²), mean ± SD
24.8 ± 3.6
25.2 ± 3.9
0.398
ASA Physical S a us, n (%)
0.512
ASA I
48 (40.00%)
52 (43.33%)
ASA II
58 (48.33%)
54 (45.00%)
ASA III
14 (11.67%)
14 (11.67%)
His o y o PONV/mo ion sickness, n (%)
32 (26.67%)
35 (29.17%)
0.668
Smoking s a us, n (%)
0.721
Non-smoke
94 (78.33%)
96 (80.00%)
Smoke
26 (21.67%)
24 (20.00%)
Table 2: Su gical and Anes he ic Cha ac e is ics
Cha ac e is ic
G oup D (n=120)
G oup O (n=120)
p- alue
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
490
Type o Su ge y, n (%)
0.996
Gene al Su ge y
44 (36.67%)
42 (35.00%)
Gynecological Su ge y
30 (25.00%)
32 (26.67%)
O hopedic Su ge y
24 (20.00%)
23 (19.17%)
U ological Su ge y
13 (10.83%)
14 (11.67%)
ENT Su ge y
9 (7.50%)
9 (7.50%)
Du a ion o Su ge y (min), mean ± SD
118.4 ± 34.2
121.6 ± 36.8
0.467
Du a ion o Anes hesia (min), mean ± SD
138.6 ± 38.4
142.3 ± 40.2
0.442
To al Fen anyl (mcg), mean ± SD
186.4 ± 52.8
192.6 ± 56.2
0.356
In aope a i e Fluid (mL), mean ± SD
1842 ± 468
1896 ± 492
0.365
Table 3: Incidence and Tempo al Pa e n o PONV
Ou come
G oup D
(n=120)
G oup O
(n=120)
Rela i e Risk (95%
CI)
p-
alue
O e all PONV (0-24 h s), n (%)
26 (21.67%)
43 (35.83%)
1.65 (1.08-2.53)
0.015
Ea ly PONV (0-6 h s), n (%)
18 (15.00%)
34 (28.33%)
1.89 (1.12-3.19)
0.012
La e PONV (6-24 h s), n (%)
13 (10.83%)
24 (20.00%)
1.85 (0.98-3.48)
0.045
Nausea only, n (%)
12 (10.00%)
15 (12.50%)
1.25 (0.62-2.53)
0.535
Vomi ing, n (%)
14 (11.67%)
28 (23.33%)
2.00 (1.11-3.62)
0.013
Mean nausea se e i y (VAS), mean ± SD
2.1 ± 1.4
3.2 ± 1.8
-
<0.001
Maximum nausea sco e (VAS), mean ± SD
4.6 ± 2.1
6.2 ± 2.4
-
<0.001
Table 4: Rescue An ieme ic Requi emen s and Pa ien Sa is ac ion
Pa ame e
G oup D (n=120)
G oup O (n=120)
p- alue
Pa ien s equi ing escue an ieme ics, n (%)
22 (18.33%)
39 (32.50%)
0.009
Time o i s escue an ieme ic (h s), mean ± SD
8.6 ± 4.2
5.2 ± 3.8
0.005
Fi s -line escue only, n (%)
16 (13.33%)
30 (25.00%)
0.023
Second-line escue equi ed, n (%)
6 (5.00%)
9 (7.50%)
0.426
To al escue doses adminis e ed
28
54
-
Mean omi ing episodes pe pa ien , mean ± SD
1.4 ± 0.6
2.1 ± 0.9
0.003
Pa ien sa is ac ion sco e (0-10), mean ± SD
8.4 ± 1.2
7.6 ± 1.5
0.001
Highly sa is ied (sco e ≥8), n (%)
91 (75.83%)
70 (58.33%)
0.003
Poo sa is ac ion (sco e <6), n (%)
7 (5.83%)
18 (15.00%)
0.021
Table 5: Ad e se E ec s
Ad e se E ec
G oup D (n=120)
G oup O (n=120)
p- alue
Headache, n (%)
8 (6.67%)
11 (9.17%)
0.478
Dizziness, n (%)
5 (4.17%)
7 (5.83%)
0.554
T ansien hype glycemia, n (%)
12 (10.00%)
4 (3.33%)
0.034
Mild seda ion, n (%)
6 (5.00%)
8 (6.67%)
0.591
Ex apy amidal symp oms, n (%)
0 (0.00%)
0 (0.00%)
-
Alle gic eac ions, n (%)
0 (0.00%)
0 (0.00%)
-
Ca dio ascula e ec s, n (%)
0 (0.00%)
0 (0.00%)
-
Wound in ec ion (7 days), n (%)
4 (3.33%)
5 (4.17%)
0.743
Any ad e se e ec , n (%)
31 (25.83%)
30 (25.00%)
0.883
Table 6: Mul i a ia e Logis ic Reg ession Analysis o P edic o s o PONV
P edic o Va iable
Adjus ed Odds Ra io
95% Con idence In e al
p-
alue
An ieme ic g oup (Ondanse on s Dexame hasone)
2.14
1.18 - 3.87
0.012
Female gende
2.84
1.52 - 5.31
0.001
His o y o PONV/mo ion sickness
2.42
1.28 - 4.58
0.007
Non-smoking s a us
1.68
0.84 - 3.36
0.142
To al opioid consump ion (pe 10 mcg en anyl)
1.06
1.02 - 1.11
0.004
Age (pe yea inc ease)
0.99
0.97 - 1.01
0.386
Du a ion o su ge y (pe 10 min inc ease)
1.03
0.98 - 1.08
0.258
Type o su ge y (gynecological s o he s)
1.56
0.82 - 2.97
0.173
DISCUSSION
Majo D . Bimal Ahluwalia, e al. Compa a i e E alua ion o Dexame hasone Ve sus Ondanse on Fo P e en ion o
Pos ope a i e Nausea and Vomi ing: A P ospec i e Obse a ional S udy. In . J Med. Pha m. Res., 6 (6): 483‐494,
2025
491
The p esen p ospec i e obse a ional s udy compa ed he e icacy o dexame hasone 8 mg e sus ondanse on 4 mg o
p e en ion o pos ope a i e nausea and omi ing in pa ien s unde going a ious su gical p ocedu es unde gene al
anes hesia. The indings demons a ed signi ican ly supe io an ieme ic e icacy o dexame hasone ac oss mul iple
ou come measu es including o e all PONV incidence, empo al pa e n o occu ence, nausea se e i y, omi ing episodes,
escue an ieme ic equi emen s, and pa ien sa is ac ion sco es. These esul s con ibu e aluable e idence o he ongoing
discussion ega ding op imal an ieme ic p ophylaxis s a egies in pe iope a i e ca e and ha e impo an implica ions o
clinical p ac ice and ins i u ional p o ocol de elopmen .
The o e all incidence o PONV obse ed in he p esen s udy was 21.67% in he dexame hasone g oup and 35.83% in he
ondanse on g oup, ep esen ing a 39.5% ela i e isk educ ion wi h dexame hasone p ophylaxis.(11) These indings a e
consis en wi h se e al p e iously published s udies ha ha e demons a ed supe io o equi alen e icacy o
dexame hasone compa ed o ondanse on. A me a-analysis by De Oli ei a e al. including 60 andomized con olled ials
ound ha dexame hasone was associa ed wi h educed PONV incidence compa ed o placebo, wi h e ec s las ing up o
24 hou s pos ope a i ely.(12) Simila ly, Wang e al. in hei ne wo k me a-analysis compa ing a ious an ieme ic agen s
epo ed ha dexame hasone anked among he mos e ec i e in e en ions o PONV p e en ion, pa icula ly o la e-
phase PONV beyond six hou s.(13) The p esen s udy co obo a es hese indings while p o iding addi ional eal-wo ld
obse a ional da a om clinical p ac ice se ings.
The empo al analysis o PONV occu ence in he cu en in es iga ion e ealed ha dexame hasone p o ided supe io
p o ec ion du ing bo h ea ly (0-6 hou s) and la e (6-24 hou s) pos ope a i e pe iods, hough he di e ence was mo e
p onounced du ing he ea ly phase. The sus ained an ieme ic e ec o dexame hasone ex ending h oughou he 24-hou
pe iod ep esen s a signi ican clinical ad an age o e ondanse on, which exhibi s a ela i ely sho e du a ion o
ac ion.(14) This p olonged e icacy may be a ibu ed o dexame hasone's longe elimina ion hal -li e o app oxima ely 3-
4 hou s compa ed o ondanse on's 3-5 hou s, as well as i s mul iple p oposed mechanisms o ac ion including an i-
in lamma o y e ec s ha may pe sis beyond measu able plasma concen a ions. Ap el e al. in hei comp ehensi e e iew
emphasized he impo ance o sus ained an ieme ic co e age, pa icula ly o ambula o y su ge y pa ien s who may
expe ience PONV a e discha ge om hospi al acili ies.(15)
Se e al in es iga o s ha e a emp ed o elucida e he op imal iming o dexame hasone adminis a ion o maximum
an ieme ic e icacy. While some s udies ha e ad oca ed o adminis a ion a induc ion o anes hesia due o
dexame hasone's delayed onse o ac ion, o he s ha e ound compa able e ec i eness when gi en a he end o su ge y.(16)
In he p esen s udy, dexame hasone was adminis e ed immedia ely be o e induc ion o anes hesia, which likely con ibu ed
o i s e ec i eness du ing he ea ly pos ope a i e pe iod when PONV incidence is ypically highes . The mechanism
unde lying dexame hasone's an ieme ic p ope ies in ol es inhibi ion o p os aglandin syn hesis, modula ion o
neu o ansmi e elease, and educ ion o in lamma o y media o s ha may con ibu e o pos ope a i e nausea.(17) These
pleio opic e ec s dis inguish dexame hasone om ondanse on's mo e speci ic 5-HT3 ecep o an agonism and may
explain he obse ed di e ences in clinical e icacy.
The signi ican ly lowe nausea se e i y sco es obse ed in dexame hasone- ea ed pa ien s ep esen an impo an pa ien -
cen e ed ou come ha ex ends beyond simple dicho omous classi ica ion o PONV p esence o absence. Pa ien s in he
dexame hasone g oup epo ed mean nausea se e i y o 2.1 on a 10-poin scale compa ed o 3.2 in he ondanse on g oup,
a di e ence ha likely ansla es in o meaning ul imp o emen in subjec i e com o and eco e y expe ience.(18) This
inding aligns wi h quali y o eco e y esea ch emphasizing ha e en mild o mode a e nausea can signi ican ly impac
pa ien sa is ac ion and willingness o unde go epea p ocedu es. The educed incidence o omi ing obse ed wi h
dexame hasone p ophylaxis (11.67% s 23.33%) ca ies pa icula clinical signi icance, as omi ing ep esen s a mo e
se e e and po en ially dange ous mani es a ion o PONV associa ed wi h isk o aspi a ion, wound complica ions, and
psychological dis ess.
The educed equi emen o escue an ieme ic medica ions in he dexame hasone g oup (18.33% s 32.50%) o e s bo h
clinical and economic ad an ages. F om a clinical pe spec i e, he need o addi ional an ieme ic in e en ions indica es
p ophylaxis ailu e and exposes pa ien s o po en ial ad e se e ec s o mul iple d ug classes. F om an economic s andpoin ,
escue an ieme ic adminis a ion inc eases nu sing wo kload, p olongs pos -anes hesia ca e uni s ays, and adds o
medica ion cos s.(19) The longe ime o i s escue an ieme ic in he dexame hasone g oup (8.6 hou s s 5.2 hou s) u he
demons a es he sus ained e ec i eness o dexame hasone h oughou he ulne able ea ly pos ope a i e pe iod when
PONV isk is g ea es .
Pa ien sa is ac ion sco es showed s a is ically and clinically signi ican imp o emen wi h dexame hasone p ophylaxis,
wi h mean sco es o 8.4 e sus 7.6 on a 10-poin scale. This di e ence, while nume ically modes , e lec s he cumula i e
impac o educed PONV incidence, lowe nausea se e i y, ewe omi ing episodes, and dec eased need o escue
in e en ions. Con empo a y pe iope a i e ca e inc easingly emphasizes pa ien - epo ed ou comes and expe ience
measu es as essen ial quali y indica o s complemen ing adi ional clinical endpoin s.(20) The co ela ion be ween
