BACKGROUND: Postoperative vomiting (POV) is a common complication after pediatric strabismus surgery. The aim of this study was to evaluate the prophylactic antiemetic effects of a combination of ondansetron with dexamethasone after strabismus surgery in children.

METHODS: In this prospective, randomized, double-blind, placebo-controlled study, 126 healthy children, aged 3-10 years, who underwent strabismus surgery under general anesthesia using sevoflurane were examined. The patients were divided randomly into three groups: Patients who received 100µgram/kg ondansetron with 100 µgram/kg dexamethasone (OD group, n = 42); 100µgram/kg ondansetron (O group, n = 42); and saline as placebo (P group, n = 42) after the induction of anesthesia. The incidence of vomiting, the patient's distress due to vomiting, the need for rescue antiemetics and parental satisfaction during the first 24 h after surgery were evaluated.

RESULTS: The incidence of vomiting in group OD (5%) and group O (17%) during the first 24 h after surgery were significantly lower than in group P (40%) (P < 0.001, P < 0.05, respectively). The level of distress of the patients in group OD during the first 6 h after surgery was significantly lower than in group P (P < 0.05). The parents in group OD were more satisfied than those in group P (P < 0.05). However, the incidence of vomiting, patient's distress, need for rescue antiemetics, and parental satisfaction were comparable between groups OD and group D.

CONCLUSIONS: A combination of ondansetron with dexamethasone and ondansetron alone were equally effective in preventing vomiting after strabismus surgery in children. However the combination of ondansetron with dexamerhasone, but not ondamsetrone alone, is more effective in reducing the level of patient's distress and incresing the level of parental satisfaction than the placebo.