Dexamethasone is a cost-effective alternative to ondansetron in preventingPONV after paediatric strabismus repair

This study evaluated the antiemetic efficacy, cost-effectiveness and clinic al utility of prophylactic ondansetron and dexamethasone compared with plac ebo in the prevention of postoperative nausea and vomiting (PONV) in 135 ch ildren (2-15 yr, ASA I-II) undergoing strabismus repair. After induction wi th halothane and nitrous oxide in oxygen or i.v. thiopental, the children r eceived i.v. dexamethasone 1 mg kg(-1) to a maximum of 25 mg, ondansetron 1 00 mug kg(-1) to a maximum of 4 mg or placebo (n=45). Episodes of PONV were recorded for the first 24 h after the operation. True outcome measures (pa rental satisfaction score, duration of stay in the postanaesthesia care uni t and fast tracking time), therapeutic outcome measures (number needed to p revent (NNTP) PONV) and the cost to benefit a child with each drug were ana lysed. The incidence and severity of PONV in the first 24 h were significan tly less in the dexamethasone and ondansetron groups than in the placebo gr oup (P<0.05). The incidence (P=0.04) and severity (P=0.03) of PONV at the 6 -24 h epoch were significantly less in the dexamethasone group than in the ondansetron group. Recovery time (P=0.07), fast tracking time (P=0.6), pare ntal satisfaction scores (P=0.08) and NNTP PONV were comparable (NNTP=2) in both the ondansetron and the dexamethasone group. The cost, to benefit a c hild with dexamethasone was approximately 22 times less than that of ondans etron.