A review of the efficacy of dexamethasone in the prevention of postoperative nausea and vomiting

AIMS OF THE REVIEW: To consider the efficacy of dexamethasone in preventing postoperative nausea and vomiting following general anaesthesia and a range of surgical procedures, compared with a placebo of sodium chloride (normal saline). To inform nurses' pharmacological knowledge of the effects of this medication during peri-operative care. BACKGROUND: Dexamethasone was serendipitously discovered to have an effect on reducing postoperative nausea and vomiting for patients receiving various chemotherapeutic regimes. Experience suggests many nurses remain unaware of the anti-emetic effect of this medication. METHODS: Multiple databases were searched and selected articles were restricted to experiments published within the past 10 years. Participants of each study had received dexamethasone or sodium chloride (not administered in combination with any other anti-emetics) preoperatively, undergone general anaesthesia and received a common surgical procedure. Thirteen research articles met these criteria and were reviewed. RESULTS: The surgical procedures represented have shown high incidences of postoperative nausea and vomiting associated with them. Importantly, 12 of the 13 trials reported significant reductions suggesting dexamethasone has a significant preventative effect in reducing the incidence of postoperative nausea and vomiting when given during induction. However, as a preventative of postoperative nausea alone, dexamethasone does not appear to have a significant effect. CONCLUSIONS: The findings clearly support the notion that dexamethasone does have anti-emetic properties. Research examining dexamethasone in combination with other drugs as a cocktail of anti-emetics is welcomed. Future research into the usefulness of dexamethasone given beyond the induction period as an anti-emetic to inform postoperative protocols of care is needed. RELEVANCE TO CLINICAL PRACTICE: Nurses in the peri-operative arena can administer this medication, when ordered, with the knowledge based on research evidence as to why it has been included in preoperative protocols. However, dexamethasone has been noted in postanaesthesia recovery care units as a clinical pathway option for the management of postoperative nausea and vomiting and no retrieved articles discuss this option.