Background: Strabismus surgery is perhaps a pediatric surgical procedure that has the strongest evidence of
postoperative nausea and vomiting (PONV) risk. This randomized controlled blind study was designed to
evaluate the efficacy of combined therapy of dexamethasone and intraoperative superhydration vs their
monotherapy on the incidence and severity of PONV and on pain intensity after pediatric strabismus surgery.
Methods: A total of 120 children aged 6 to 12 years undergoing strabismus surgery were randomized to
equally 3 groups to receive 0.15 mg/kg dexamethasone (dexamethasone group) or intraoperative superhydration
of lactated Ringer's solution in a dose of 30 mL/kg per fasting time (superhydration group), or a
combination of dexamethasone and intraoperative fluid in the same strategy (combination therapy group).
The incidence and severity of PONV and pain using visual analog scale score, and need for supplemental
antiemetic and analgesic therapy and their consumptions were assessed and compared in the 3 studied
groups for 24 hours postoperatively.
Results: The incidence of PONV and postoperative vomiting was significantly lower (PN .001) in the combination
therapy group (5% and 5% respectively) compared with the dexamethasone group (35% and 30%)
and superhydration group (32.5% and 35%). There was no significant difference among patients in the
superhydration group and dexamethasone group in the cumulative incidences of PONV in the whole
24 hours postoperatively. Postoperative aggregated visual analog scale pain score and total acetaminophen
consumption showed a significant reduction (PN .05) in the combination therapy group together with significant
prolongation of time to the first analgesic request compared with both the superhydration group and
the dexamethasone group.
Conclusion: Combined therapy of 0.15 mg/kg dexamethasone 1 minute before induction and intraoperative
fluid superhydration is an effective and safe way to reduce PONV and pain better than monotherapy of
dexamethasone, or intraoperative superhydration separately for pediatric strabismus surgery.