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Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV.A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. Group P received the placebo (0.9% normal saline 2 ml) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia.We found that during the postoperative period of 1-8 h, patients in Group D reported a lower incidence of PONV (24%) than those in Group P (39%, p0.001). Patients in Group D also requested less rescue anti-emetic (17%) than those in Group P (30%, p0.05). The same phenomenon was also noted in the 8-to-24-hour interval (PONV 4% vs. 12%, p0.05 and rescue anti-emetic 3% vs. 9%, p0.05 in Group D vs. Group P, respectively.)We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.

We performed a prospective, randomized, double-blind study to compare the effect of epidural dexamethasone on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were randomly assigned to two groups: Group I patients received 25 mL 2% lidocaine with epinephrine 1:200,000 and 1 mL dexamethasone (5 mg) epidurally. Patients were interviewed at 24,48, and 72 h postoperatively using a standard visual analog scale (VAS) for evaluation of postepidural backache. A patient was considered to have postepidural backache when the postoperative VAS score was higher than the preoperative score. The incidence of postepidural backache in Group I patients for the 3 days were 22.8%, 17.4%, and 9.2%, all of which were significantly more frequent than observed in Group II patients (7.4%,5.6%, and 2.8%, P0.01). The severity and duration of postepidural backache were also significantly decreased in Group II patients. In our study, there was a significant association between postepidural backache and multiple attempts at epidural needle insertion. In summary, epidural dexamethasone reduced the incidence and severity of postepidural backache.