PMID- 16117980
OWN - NLM
STAT- MEDLINE
DCOM- 20060531
LR  - 20220330
IS  - 0149-2918 (Print)
IS  - 0149-2918 (Linking)
VI  - 27
IP  - 6
DP  - 2005 Jun
TI  - Effects of dexamethasone in preventing postoperative emetic symptoms after total 
      knee replacement surgery: a prospective, randomized, double-blind, 
      vehicle-controlled trial in adult Japanese patients.
PG  - 740-5
AB  - BACKGROUND: Postoperative emetic symptoms (nausea, retching, and vomiting) are 
      common following total joint replacement, with an incidence as high as 83% when 
      no prophylactic antiemetic is provided. However, most antiemetics currently used 
      in Japan, such as antihistamines (eg, hydroxyzine), butyrophenones (eg, 
      droperidol), and dopamine receptor antagonists (eg, metoclopramide), have been 
      associated with adverse effects (AEs), such as excessive sedation, hypotension, 
      dry mouth, dysphoria, hallucinations, and extrapyramidal symptoms. OBJECTIVE: The 
      aim of this study was to assess the efficacy and tolerability of 3 doses of 
      intravenous dexamethasone monotherapy versus vehicle in preventing emetic 
      symptoms after total knee replacement performed under combined general and 
      epidural anesthesia. METHODS: This prospective, randomized, double-blind, 
      vehicle-controlled trial was conducted at the Department of Anesthesiology, 
      University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan. Adult 
      Japanese patients scheduled to undergo total knee replacement were eligible. 
      Patients were randomly assigned to 1 of 4 treatment groups: dexamethasone 4, 8, 
      or 16 mg, or vehicle (control). Patients received combination anesthesia with 
      sevoflurane and nitrous oxide in pure oxygen (general) and lidocaine (epidural). 
      Study drugs were administered intravenously after the completion of surgery. An 
      investigator blinded to treatment assignment monitored patients for emetic 
      symptoms for 24 hours after the patient awoke. Patients rated their satisfaction 
      with the study drug using a linear, 11-point scale (0 = complete satisfaction to 
      10 = complete dissatisfaction). Tolerability was assessed by the study 
      investigator using spontaneous reporting and patient interview. RESULTS: A total 
      of 80 patients were enrolled (58 women, 22 men; mean [SD] age, 59 [10] years; 
      mean [SD] height, 154 [7] cm; mean [SD] body weight, 55 [7] kg; 20 patients per 
      treatment group). The demographic, clinical, and surgical data were comparable 
      between the 4 treatment groups. The rates of emesis-free patients were 35% (7 
      patients), 70% (14), and 75% (15) with dexamethasone 4, 8, and 16 mg, 
      respectively, compared with 30% (6) with vehicle (P = NS, 0.013, and 0.005, 
      respectively). Median (range) patient satisfaction scores were significantly 
      higher in the groups receiving dexamethasone 8 and 16 mg (both, 0.0 [0-9]) 
      compared with controls (6.0 [0-10]) (P = 0.013 and 0.008, respectively). This 
      effect was not found with the 4-mg dose. No clinically serious AEs attributed to 
      the study drug were observed in any of the 4 treatment groups. CONCLUSIONS: In 
      this study of a small, select group of adult Japanese patients undergoing total 
      knee replacement, the rates of emesis-free patients were higher with 
      dexamethasone 8 and 16 mg compared with vehicle 24 hours after anesthesia 
      induction. This effect was not found with the 4-mg dose. All treatments were well 
      tolerated.
FAU - Fujii, Yoshitaka
AU  - Fujii Y
AD  - Department of Anesthesiology, University of Tsukuba Institute of Clinical 
      Medicine, Japan. yfujii@md.tsukuba.ac.jp
FAU - Nakayama, Masahiro
AU  - Nakayama M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Retracted Publication
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antiemetics)
RN  - 7S5I7G3JQL (Dexamethasone)
SB  - IM
RIN - Clin Ther. 2018 Apr 30;:. PMID: 29724497
MH  - Adult
MH  - Aged
MH  - Antiemetics/administration & dosage/adverse effects/*therapeutic use
MH  - Arthroplasty, Replacement, Knee/adverse effects/*methods
MH  - Dexamethasone/administration & dosage/adverse effects/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Double-Blind Method
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Injections, Intravenous
MH  - Japan
MH  - Male
MH  - Middle Aged
MH  - Postoperative Nausea and Vomiting/etiology/*prevention & control
MH  - Prospective Studies
MH  - Treatment Outcome
EDAT- 2005/08/25 09:00
MHDA- 2006/06/01 09:00
CRDT- 2005/08/25 09:00
PHST- 2005/04/04 00:00 [accepted]
PHST- 2005/08/25 09:00 [pubmed]
PHST- 2006/06/01 09:00 [medline]
PHST- 2005/08/25 09:00 [entrez]
AID - S0149-2918(05)00093-7 [pii]
AID - 10.1016/j.clinthera.2005.05.011 [doi]
PST - ppublish
SO  - Clin Ther. 2005 Jun;27(6):740-5. doi: 10.1016/j.clinthera.2005.05.011.