Intravenous Versus Intraperitoneal Dexamethasone Effects on Postoperative Nausea, Vomiting, and Pain After Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial

Objective: This study compared the effects of intraperitoneal (i.p.) versus intravenous (i.v.) dexamethasone injection on reducing postoperative nausea and vomiting (PONV) as well as pain after gynecologic laparoscopic surgery. Materials and Methods: In this randomized, triple-blinded clinical trial, 90 women who underwent laparoscopic surgery for gynecologic indications were divided randomly into 3 groups: (1) Group IV-D, single 8-mg dose of i.v. dexamethasone intraoperatively with i.p. placebo; (2) IP-D, single 8-mg dose of i.p. dexamethasone with i.v. placebo; and (3) placebo, i.v. and i.p. distilled water. PONV and pain intensity were measured every 6 hours postoperatively in the first 24 hours with a visual analogue scale (VAS). Results: Ninety patients were in the 3 groups, with 30 patients in each group. The mean ± standard deviation age of participants was 29.38 ± 4.66 years. There was a significant difference in VAS pain at 6, 12, 18, and 24 hours after surgery between groups IV-D and IP-D ( p < 0.001), groups IP-D and placebo ( p < 0.001), and groups IV-D and placebo ( p < 0.001). PONV VAS at 6, 12, 18 and 24 hours were significantly different between groups IV-D and IP-D ( p < 0.001), groups IP-D and placebo ( p < 0.001), and groups IV-D and placebo ( p < 0.001). Conclusions: Dexamethasone significantly reduced incidence and severity of PONV and pain in patients after laparoscopic gynecologic surgery, more so when using i.p. injection. Dexamethasone reduced the need for opioid analgesics. (J GYNECOL SURG 39:213)