Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: A randomized, double-blind, placebo-controlled trial

Background: Nausea and vomiting during and after spinal anaesthesia for caesarean section are distressing to the patient. This study was undertaken to evaluate the efficacy and safety of granisetron, droperidol and metoclopramide for the prevention of nausea and vomiting in parturients undergoing caesarean section under spinal anaesthesia.
Methods: In a randomized, double-blind, placebo-controlled trial, 120 patients received granisetron 3 mg, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) ( n =30 of each) i. v. immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during and after spinal anaesthesia for caesarean section.
Results: The incidence of intraoperative, post-delivery nausea and vomiting was 13%, 17%, 20% and 63% after administration of granisetron, droperidol, metoclopramide and placebo, respectively; the corresponding incidence during 0–3 h after surgery was 7%, 27%, 27% and 43%; the corresponding incidence during 3–24 h after surgery was 7%, 20%, 23% and 37% ( P <0.05; overall Fisher's exact probability test). No clinically important adverse events were observed in any of the groups.
Conclusion: Granisetron is highly effective for preventing nausea and vomiting during and after spinal anaesthesia for caesarean section. Droperidol and metoclopramide are effective for the prevention of intraoperative, post-delivery emesis, but are ineffective for the reduction of the incidence of postoperative emesis.     

反相高效液相色谱法测定格拉司琼血药浓度

目的 :建立格拉司琼血药浓度的反相高效液相色谱测定方法。方法 :以甲醇 0 .0 5mol·L-1醋酸钠缓冲液 (pH6 .0 ,含0 .2 5 %三乙胺 ) (83∶17)为流动相 ,激发波长为 30 5nm ,发射波长 36 5nm ,血浆样品采用乙酸乙酯提取后进样。结果 :格拉司琼在0 .2～ 15 μg·L-1浓度范围内线性关系良好 ,平均回收率 (98.6± 7.4) % ,日内RSD≤ 4.9% ,日间RSD≤ 8.5 %。结论 :方法简便 ,准确 ,灵敏 ,可用于格拉司琼血药浓度测定。     

格拉司琼治疗53例顺铂所致呕吐临床观察

[目的]观察格拉司琼对顺铂所致恶心、呕吐的临床疗效.[方法]53例接受含顺铂联合化疗的恶性肿瘤患者进行2个疗程的自身对照,随机分格拉司琼与胃复安组,比较治疗效果.[结果]格拉司琼组对恶心、呕吐的完全控制率和有效控制率明显优于胃复安组(P＜0.05).两组间不良反应发生率无明显差异.[结论]格拉司琼可作为预防化疗引起的恶心、呕吐的优选药物.     

格拉司琼与恩丹西酮防治食管癌术后化疗所致恶心呕吐的疗效对比

目的：比较格拉司琼与恩丹西酮防治食管癌术后患者化疗引起恶心、呕吐的作用及毒副反应。方法：回顾性研究439例食管癌术后化疗患者的临床资料，比较格拉司琼和恩丹西酮的治疗效果及毒副反应。结果：吻合VI位于颈部患者比位于胸内患者易发生恶心、呕吐。格拉司琼对化疗后急性（1d）恶心、呕吐有效率为81．6％，延迟性恶心呕吐（2—5d）的有效率分别为75．0％、64．2％、60．8％、56．1％。恩丹西酮对化疗后急性恶心、呕吐有效率为71．4％，延迟性恶心、呕吐的有效率分别为68．7％、57．7％、52．0％、47．1％，两组差异显著（P〈0．05），格拉司琼治疗效果优于恩丹西酮。两者不良反应基本相似。结论：格拉司琼对于防治食管癌术后患者化疗所致恶心、呕吐效果较好。     

Serotonin receptor blockade increases food intake and body weight after total gastrectomy in rats

BACKGROUND: Total gastrectomy often results in early satiety and loss of body weight. Serotonin inhibits food intake, and postprandial serotonin release is increased after total gastrectomy. Serotonin might contribute to early satiety and loss of body weight after total gastrectomy. METHODS AND MATERIALS: Food intake and body weight were investigated with an automated recording system in gastrectomized rats 1-12 months postoperatively. Rats were treated with metergoline, a 5-hydroxytryptamine (5-HT)(1/2) receptor antagonist, two different 5-HT(3) receptor antagonists, a combination of metergoline and devazepide, a cholecystokinin (CCK) a receptor antagonist, or vehicle. In addition, metergoline or vehicle was applied continuously by an intraperitoneal osmotic minipump for 7, 28, or 84 days after total gastrectomy. RESULTS: Metergoline treatment resulted in a dose-dependent increase in food intake in gastrectomized rats. 5-HT(3) receptor antagonist treatment had no effect, and devazepide in addition to metergoline did not further stimulate food intake. Metergoline increased food intake at 1, 3, and 6 months postoperatively by up to 45% (24-h cumulative food intake [FI], 6 months: vehicle 3.83 +/- 0.10, metergoline 5.52 +/- 0.15 g/100 g body weight (BW), P < 0.0001). Chronic metergoline treatment for 7, 28, or 84 days significantly increased food intake after total gastrectomy compared to vehicle treatment (FI 7 days: vehicle 30.83 +/- 0.71, metergoline 36.27 +/- 0.85 g/100 g BW; P < 0.0002; average weekly FI during 28 days; vehicle 31.23 +/- 0.22, metergoline 36.83 +/- 0.33 g/100 g BW, P < 0.0001; average weekly FI during 84 days: vehicle 33.02 +/- 0.59, metergoline 35.07 +/- 0.48 g/100g BW, P < 0.008), and there was a significant body weight increase compared to vehicle treatment (7 days: DeltaBW vehicle -0.7 +/- 1.2 g vs DeltaBW metergoline 9.0 +/- 2.1 g, P < 0.001; 28 days: DeltaBW vehicle 0.3 +/- 2.2 vs DeltaBW metergoline 13.0 +/- 2.3, P < 0.001; 84 days: DeltaBW vehicle 25.7 +/- 10.2 vs DeltaBW metergoline 49.5 +/- 7.2, P < 0.04). Treatment for 84 days resulted in a significant body weight gain, while vehicle treatment had no effect (vehicle: 438 +/- 11 g vs 464 +/- 12 g, P < 0.2, n.s.; metergoline: 448 +/- 9 g vs 498 +/- 10 g, P < 0.007). CONCLUSIONS: Inhibition of food intake by serotonin might contribute to early satiety and loss of body weight after total gastrectomy.     

Granisetron prevents nausea and vomiting during spinal anaesthesia for caesarean section

Background: Nausea and vomiting during spinal anaesthesia for caesarean section are common and unpleasant complications. This study was undertaken to evaluate the efficacy of granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, for prophylactic treatment of nausea and vomiting in parturients undergoing nonemergent caesarean section under spinal anaesthesia.
Methods: In a randomized, double-blind, placebo-controlled trial, 100 patients, 21–38 years, received either placebo (saline) or granisetron at 3 different doses (20 μg · kg^-1, 40 μg · kg^-1 or 80 μg · kg^-1) (n=25 for each) intravenously immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during spinal anaesthesia for caesarean section.
Results: The treatment groups were similar with regard to maternal characteristics and operative management. The incidence of nausea and vomiting was 64%, 52%, 14% and 12% after administration of placebo and granisetron in a dose of 20 μg · kg^-1, 40 μg · kg^-1 and 80 μg · kg^-1, respectively ( P <0.05; overall Fisher's exact probability test). No clinically important adverse effects were observed in any group.
Conclusions: Prophylactic use of granisetron in a minimum dose of 40 μg · kg^-1 is effective for preventing nausea and vomiting during spinal anaesthesia for caesarean section.
© Acta Anaesthesiologiat Scandinavica 42 (1998)     

Clinical usefulness of oral granisetron hydrochloride for alleviation of delayed nausea and vomiting induced by CPT-11

This open label pilot study evaluated the safety and efficacy of the oral 5-HT3 receptor antagonist granisetron for prophylaxis of delayed chemotherapy-induced nausea and vomiting (CINV) in 30 patients with advanced or recurrent colorectal cancer. Patients were studied during two cycles of a 5-week regimen with irinotecan (CPT-11) and UFT. Patients received prophylactic anti-emetic therapy that included intravenous granisetron. If Grade 1 or higher severity gastrointestinal symptoms occurred during 6 days after CPT-11 administration in Cycle 1, then oral granisetron was administered daily for the following 5 days of CPT-11 in Cycle 2. Sixteen patients (53.3%) experienced delayed CINV in Cycle 1. The incidence of Grade 2 or higher vomiting was 32.1% and 27.7% in Cycles 1 and 2 in males (P = 0.554) respectively, and 54.6% and 32.4% in females (P = 0.001) respectively. Granisetron is effective against delayed Grade 2 or higher vomiting induced by CPT-11/UFT in female patients, although granisetron alone may not sufficiently control nausea induced by this regimen.     

Comparison of granisetron and granisetron plus dexamethasone for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

BACKGROUND: Laparoscopic cholecystectomies are associated with an appreciably high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the effectiveness of granisetron plus dexamethasone with granisetron alone for the prevention of postoperative nausea and vomiting in patients after laparoscopic cholecystectomy. METHODS: In a randomized, double-blind study, 120 patients of both sexes received granisetron 40 micro g kg-1 alone or granisetron 40 micro g kg-1 plus dexamethasone 8 mg (n=60 of each) intravenously immediately before induction of anesthesia. Perioperative anesthetic care was standardized in all patients. Patients were then observed for 24 h after administration of the study drug. RESULTS: A complete response (defined as no PONV and no need for another rescue antiemetic) was achieved in 83% of the patients given granisetron and in 95% of the patients given granisetron plus dexamethasone (P<0.05). The overall cumulative incidences (0-24 h) of PONV were 11 (18.3%) in the granisetron and three (5%) in the combination group. No difference in adverse events were observed in any of the groups. CONCLUSION: The combination (granisetron plus dexamethasone) further increases the chance of complete response than granisetron alone. Therefore, the combination might be considered clinically relevant in a high risk setting.