Abstract
Background: Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia. Methods: Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (8 mg ondansetron, n= 108), Group B (10 mg dexamethasone plus mosapride, n= 108), or Group C (three doses of 10 mg dexamethasone plus mosapride, n=116). The primary outcome was the total incidence of PONV during postoperative 48 hours. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications. Results: Patients in Group C experienced a lower incidence of total PONV (29.3%, p= 0.001), severe nausea (1.72%, p<0.001) and a higher incidence of complete response (70.69%, p=0.001) than did patients in Groups A and B. Moreover, less rescue antiemetic treatment and postoperative opioid consumption was needed in Group C (p<0.05). Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups. Conclusion: Prophylactic use of mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.
Perioperative intravenous glucocorticoids can decrease postoperative nausea and vomiting and pain in total joint arthroplasty
