Evidence-Based Practice the Use of Steroids in Preventing Postoperative Nausea and Vomiting

Christian, Willecia, Huda LaCroix, and Joyce Conley

OBJECTIVE

The main objective of this literature review was to determine if postoperative nausea and vomiting (PONV) could be prevented in patients undergoing surgery with the use of steroids.

CLINICAL QUESTION

“In patients undergoing general anesthesia, what is the effect of steroid use during surgery (such as dexamethasone and methylprednisolone) on reducing postoperative nausea and vomiting compared with patients who did not receive steroids?”

METHOD

A comprehensive search of PubMed and the Cochrane Database was completed to find articles on the clinical question. The search resulted in a review of six articles.

ACCEPTED PRACTICE

Currently there are no practice guidelines for the use of steroids in the reduction of PONV according to AANA or ASA.

CRITICAL APPRAISAL

The majority of the studies appraised found that dexamethasone or methylprednisolone is effective in reducing PONV. Three of the studies used adjunct therapy (another treatment [antiemetics] used together with the primary treatment [steroids]) in combination or in comparison with steroids. The results still favored the use of steroids (dexamethasone and methylprednisolone) in reducing PONV when combined with other therapies. The results also identified that combination therapy was more effective in reducing PONV than with the use of dexamethasone alone.

CLINICAL PRACTICE IMPLICATIONS

The consensus of the studies state that dexamethasone is a safe and inexpensive drug to use. Methylprednisolone not only reduced PONV it also reduced postoperative fatigue and postoperative opioid consumption. Based on this, future studies to consider should focus on the effect of steroids in combinat