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. 2020 Oct 19;2020(10):CD012859. doi: 10.1002/14651858.CD012859.pub2

Gupta Priyanka 2014.

Study characteristics
Methods Study design: randomized controlled trial
Study grouping: 3 groups, monoprophylaxis and combination prophylaxis
Participants Baseline characteristics
Dexamethasone + granisetron (group G)

  • Assessed for eligibility (n): ‐

  • Enrolled (n): ‐

  • Randomized (n): 25

  • Received treatment (n): 25

  • Analysed (n): 25

  • Age (mean ± SD, median (IQR), median (range)): 35.64 ± 14.1

  • Weight (mean ± SD, median (IQR), median (range)): 51 ± 10.308

  • BMI (mean ± SD, median (IQR), median (range)): NA

  • ASA I/II/III/IV (n): NA/NA/NA/0

  • Gender (female in %): 52

  • Non‐smoker (%): 80

  • History of PONV/motion sickness (%): 0

  • Type of general anaesthesia: inhalational anaesthesia (isoflurane, N₂O)

  • Duration of anaesthesia or surgery (in min; as mean or median): 258

  • Use of perioperative opioids (if yes, which?): 249.8 µg intraoperative fentanyl

  • Type of surgery: craniotomy for brain tumour


Dexamethasone + ondansetron (group O)

  • Assessed for eligibility (n): ‐

  • Enrolled (n): ‐

  • Randomized (n): 25

  • Received treatment (n): 25

  • Analysed (n): 25

  • Age (mean ± SD, median (IQR), median (range)): 36.56 ± 14.54

  • Weight (mean ± SD, median (IQR), median (range)): 50.2 ± 11.857

  • BMI (mean ± SD, median (IQR), median (range)): NA

  • ASA I/II/III/IV (n): NA/NA/NA/0

  • Gender (female in %): 52

  • Non‐smoker (%): 88

  • History of PONV/motion sickness (%): 0

  • Type of general anaesthesia: inhalational anaesthesia (isoflurane, N₂O)

  • Duration of anaesthesia or surgery (in min; as mean or median): 239

  • Use of perioperative opioids (if yes, which?): 220.4 µg intraoperative fentanyl

  • Type of surgery: craniotomy for brain tumour


Dexamethasone (group D)

  • Assessed for eligibility (n): ‐

  • Enrolled (n): ‐

  • Randomized (n): 25

  • Received treatment (n): 25

  • Analysed (n): 25

  • Age (mean ± SD, median (IQR), median (range)): 37.04 ± 12.74

  • Weight (mean ± SD, median (IQR), median (range)): 53.6 ± 9.41

  • BMI (mean ± SD, median (IQR), median (range)): NA

  • ASA I/II/III/IV (n): NA/NA/NA/0

  • Gender (female in %): 48

  • Non‐smoker (%): 88

  • History of PONV/motion sickness (%): 0

  • Type of general anaesthesia: inhalational anaesthesia (isoflurane, N₂O)

  • Duration of anaesthesia or surgery (in min; as mean or median): 246

  • Use of perioperative opioids (if yes, which?): 248 µg intraoperative fentanyl

  • Type of surgery: craniotomy for brain tumour


Included criteria: ASA I to III, adult patients of either sex, scheduled for elective craniotomy for brain tumour
Excluded criteria: Glasgow coma scale 14, not extubated at end of surgery, on preoperative antiemetic therapy, previous history of PONV/motion sickness/gastro‐oesophageal reflux disease, history of allergy to 5‐HT3 antagonists
Pretreatment: baseline characteristics (age, weight): no; (ASA): unclear. Potential effect modifiers (gender, duration of anaesthesia, non‐smoker, history of PONV/motion sickness, perioperative opioids): no
Interventions Intervention characteristics
Dexamethasone + granisetron (group G)

  • Dose: dexamethasone 8 mg, granisetron 1 mg

  • Time point of administration: dexamethasone at induction, granisetron at the time of dural close

  • Route of administration: IV

  • Rescue antiemetics (if yes, which?): metoclopramide 10 mg IV


Dexamethasone + ondansetron (group O)

  • Dose: dexamethasone 8 mg, ondansetron 1 mg

  • Time point of administration: dexamethasone at induction, ondansetron at the time of dural close

  • Route of administration: IV

  • Rescue antiemetics (if yes, which?): metoclopramide 10 mg IV


Dexamethasone (group D)

  • Dose: 8 mg

  • Time point of administration: dexamethasone at induction, saline at the time of dural close

  • Route of administration: IV

  • Rescue antiemetics (if yes, which?): metoclopramide 10 mg IV
Outcomes PONV (0 to 24 hours)

  • Outcome type: dichotomous outcome


Headache (0 to 48 hours)

  • Outcome type: dichotomous outcome


Constipation (0 to 48 hours)

  • Outcome type: dichotomous outcome


Sedation/drowsiness (0 to 48 hours)

  • Outcome type: dichotomous outcome
Identification Sponsorship source: NA
Country: India
Setting: inpatient
Author's name: Mayank Gupta
Institution: Department of Anaesthesia and Intensive Care, Vardhaman Mahavir Medical College and Safdarjung Hospital, Saket, New Delhi, India
Email: drm_gupta@yahoo.co.in
Address: 14, Himvihar Apartments, I.P. Extension, New Delhi ‐ 110 092, India
Language: English
Duration of study: NA
Trial registry number: NA
Study's primary outcome: NA
Notes None
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "at the time of dura closure, patients were randomly assigned to one of the three groups using envelope method to receive"
Judgement comment: no further information on randomization method provided
Allocation concealment (selection bias) Unclear risk Quote: "using envelope method to receive"
Judgement comment: not stated that envelopes were sequentially numbered, opaque, and sealed (SNOSE)
Blinding of participants and personnel (performance bias)
All outcomes Unclear risk Quote: "...the time of dural closure. Study medications were prepared by an anesthetist not involved in PONV monitoring in identical 2 ml syringes. Neuromuscular blockade was reversed with..."
Judgement comment: anaesthesiologist was not blinded but only received information about group allocation at dural closure. Impact on anaesthesia unknown
Blinding of outcome assessment (detection bias)
All outcomes Low risk Quote: "anesthetists who were blinded to group allocation recorded each episode of nausea, retching and vomiting"
Incomplete outcome data (attrition bias)
All outcomes Low risk Judgement comment: no missing outcome data
Selective reporting (reporting bias) Unclear risk Judgement comment: no reference to a study protocol or trial registry number reported
Other bias Unclear risk Quote: "...the study, 25 in each group. There were no significant differences in demographic profile [Table 1], intra‐operational characteristics [Table 2], type and anatomical location of intracranial tumors among the three groups [Table 3]. A complete response (no PONV..."
Judgement comment: baseline characteristics (age, weight): no; (ASA): unclear. Potential effect modifiers (gender, duration of anaesthesia, non‐smoker, history of PONV/motion sickness, perioperative opioids): no