Prophylactic antiemetic therapy with ondansetron,tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized,double-blind comparison with placebo |
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Authors: | Mohamed Naguib Abdel Karim El Bakry Mohammed H B Khoshim Amir B Channa Mohamed El Gammal Kariman El Gammal Yasser S Elhattab Munir Attia Randa Jaroudi Abdulaziz Saddique |
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Institution: | 1. Department of Anaesthesia and ICU, King Khalid University Hospital, PO Box 7805, 11472, Riyadh, Saudi Arabia 2. Department of Surgery, Faculty of Medicine at King Khalid University Hospital. Faculty of Medicine at King Khalid University Hospital, Saudi Arabia 3. Department of Pharmacy, Faculty of Medicine at King Khalid University Hospital. Faculty of Medicine at King Khalid University Hospital, Saudi Arabia
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Abstract: | Purpose Postoperative nausea and vomiting (PONV) is a distressing adverse effect of general anaesthesia. The aim of the current study was to compare the antiemetic activity of different 5-hydroxytryptamine3 receptor antagonists with that of metoclopramide and placebo. Methods In a prospective, randomized, double-blind study we have compared the antiemetic activity of the prophylactic administration of ondansetron 4 mg, tropisetron 5 mg and granisetron 3 mg with that of metoclopramide 10 mg and placebo in 132 patients undergoing laparoscopic cholecystectomy. All study drugs and placebo were given as a short iv infusion ten minutes before the induction of anaesthesia. Perioperative anaesthetic care was standardized in all patients. Nausea and vomiting were assessed by direct questioning of the patient at 1, 4, 9, 12, 18 and 24 hr after recovery from anaesthesia. If patients experienced nausea and/or vomiting, rescue antiemetic treatment (metoclopramide 10 mg iv) was administered. Results For the 24-hr recovery period after surgery, the percentages of emesis-free patients were 65.5%, 52%, 48%, 29.2% and 27.6% in the ondansetron, granisetron, tropisetron, metoclopramide and placebo groups, respectively. Prophylactic antiemetic treatment with ondansetron resulted in a lower incidence (P = 0.02) of PONV than with metoclopramide or placebo. The times at which rescue antiemetic was first received were longer (P < 0.01) in ondansetron group than in the placebo and metoclopramide groups. There were no statistical differences between ondansetron, tropisetron and granisetron groups. Conclusions Ondansetron, when given prophylactically resulted in a significantly lower incidence of PONV than metoclopramide and placebo. Metoclopramide was ineffective. |
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