Der Einfluss einer antiemetischen Prophylaxe auf die postoperative Erholung nach operativer Weisheitszahnentfernung in Intubationsnarkose : ein Vergleich von Dexamethason mit Droperidol und Placebo

Abstract

Postoperative nausea and vomiting (PONV) are common complications after general anaesthesia, which influence the postoperative recovery as well as the time to discharge in an ambulatory setting. Additional factors like pain, edema, poor oral intake and psychological side effects may also influence the postoperative course. In this prospective randomized placebo-controlled double-blind study the clinical efficacy of 8 mg dexamethasone versus 1,25 mg droperidol was investigated for the prevention of PONV, postoperative pain, edema and postoperative recovery. 150 patients scheduled for the removal of 2 to 4 third molars receiving standardized general anaesthesia were enrolled in this investigation. 30 minutes, 4, 8, and 24 hours postoperatively pain and nausea were assessed using visual analogue scales. In addition, anxiety and state of tension using the Erlanger anxiety and tension-scale, emetic episodes, retching as well as the use of antiemetic and analgesic medication were evaluated. On the following day patients’ satisfaction was measured using the Quality of Recovery-Score, side effects were documented and the postoperative swelling was clinically and sonograhically examined. 147 patients were included in the analysis. Patients’ characteristics were comparable in all three groups. The predicted risk for PONV using Apfel’s simplified score was about 36% for all groups. The need for anaesthetics and the duration of anaesthesia and operation were also similar. After induction of anaesthesia patients receiving droperidol had a significantly increased heart rate compared with placebo and after dexamethasone a significantly higher blood pressure, both without any clinical consequences. The incidence of PONV was 62% in the placebo group, 55% after droperidol and 42% after dexamethasone (differences were not significant). Late PONV occurred significantly more often with droperidol compared to dexamethasone use. In turn, the use of antiemetic drugs was significantly higher in the placebo group. Following dexamethasone patients showed lower pain levels and had a significantly reduced need for analgesic medication from 8 to 24 hours postoperative. Dexamethasone significantly facilitated the early tolerance of food and an earlier mobilization. Patients from the dexamethasone group had less sedation and mood swings. Anxiety and state of tension were significantly improved after dexamethasone. Other side effects were not detected in any group. Patients from the dexamethasone group could fall asleep significantly better even though the quality of sleep was equal between the groups. The clinical and sonographical examination of facial edema showed a significantly reduced swelling as well as less trismus for patients receiving dexamethasone. Sensory disturbances did not differ between the groups. Furthermore patients’ satisfaction and quality of recovery were significantly improved by dexamethasone. This study provides evidence that a single prophylactic dose of dexamethasone has a good clinical efficacy in the prevention of common complications after removal of wisdom teeth in general anaesthesia. In combination with a low NNT, a favourable price and no evidence of relevant side effects dexamethasone treatment may be recommended for patients scheduled for this intervention