Comparison of dexamethasone or intravenous fluids or combination of both on postoperative nausea, vomiting and pain in pediatric strabismus surgery

Background: Strabismus surgery is perhaps a pediatric surgical procedure that has the strongest evidence of postoperative nausea and vomiting (PONY) risk. This randomized controlled blind study was designed to evaluate the efficacy of combined therapy of dexamethasone and intraoperative superhydration vs their monotherapy on the incidence and severity of PONV and on pain intensity after pediatric strabismus surgery. Methods: A total of 120 children aged 6 to 12 years undergoing strabismus surgery were randomized to equally 3 groups to receive 0.15 mg/kg dexamethasone (dexamethasone group) or intraoperative superhydration of lactated Ringer's solution in a dose of 30 mL/kg per fasting time (superhydration group), or a combination of dexamethasone and intraoperative fluid in the same strategy (combination therapy group). The incidence and severity of PONY and pain using visual analog scale score, and need for supplemental antiemetic and analgesic therapy and their consumptions were assessed and compared in the 3 studied groups for 24 hours postoperatively. Results: The incidence of PONV and postoperative vomiting was significantly lower (P>.001) in the combination therapy group (5% and 5% respectively) compared with the dexamethasone group (35% and 30%) and superhydration group (32.5% and 35%). There was no significant difference among patients in the superhydration group and dexamethasone group in the cumulative incidences of PONV in the whole 24 hours postoperatively. Postoperatiye aggregated visual analog scale pain score and total acetaminophen consumption showed a significant reduction (P>.05) in the combination therapy group together with significant prolongation of time to the first analgesic request compared with both the superhydration group and the dexamethasone group. Conclusion: Combined therapy of 0.15 mg/kg dexamethasone 1 minute before induction and intraoperative fluid superhydration is an effective and safe way to reduce PONY and pain better than monotherapy of dexamethasone, or intraoperative superhydration separately for pediatric strabismus surgery. (C) 2016 Elsevier Inc. All rights reserved.