H Quaynor1, J C Raeder. 1. Department of Anesthesia, Kongsberg Hospital, Ullevaal University Hospital, Oslo, Norway. hen-qua@frisurf.no
Abstract
BACKGROUND:Ondansetron has a well documented antiemetic prophylactic effect, whereas in most studies of postoperative nausea and vomiting (PONV), metoclopramide is less efficacious. This can be attributed to the short-lasting effect of metoclopramide when a low dose is given at the beginning of surgery. We wanted to test a 20-mg dose of metoclopramide given at the end of surgery, using ondansetron 8 mg as a reference. METHODS:122 patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were studied in a randomized, double-blind study design. At the end of the procedure, the patients received either metoclopramide 20 mg or ondansetron 8 mg intravenously. The patients were observed for 24 h for PONV, pain, side-effects and need for rescue antiemetic medication. RESULTS: No significant differences in the incidence of PONV or need for rescue antiemetic treatment was observed in the 0-24 h postoperative study period. The overall incidence of PONV was 43% in the ondansetron group and 47% in the metoclopramide group. The ondansetron patients had a significantly higher incidence of moderate or strong pain during the postoperative observation period (61% vs. 35% in the metoclopramide group) (P < 0.05). No significant differences in side-effects between the groups were observed. CONCLUSIONS:Metoclopramide 20 mg i.v. given at the end of laparoscopic cholecystectomy resulted in a similar incidence of PONV compared with ondansetron 8 mg. The patients receiving metoclopramide had less pain than the patients receiving ondansetron.
RCT Entities:
BACKGROUND:Ondansetron has a well documented antiemetic prophylactic effect, whereas in most studies of postoperative nausea and vomiting (PONV), metoclopramide is less efficacious. This can be attributed to the short-lasting effect of metoclopramide when a low dose is given at the beginning of surgery. We wanted to test a 20-mg dose of metoclopramide given at the end of surgery, using ondansetron 8 mg as a reference. METHODS: 122 patients scheduled for elective laparoscopic cholecystectomy under general anesthesia were studied in a randomized, double-blind study design. At the end of the procedure, the patients received either metoclopramide 20 mg or ondansetron 8 mg intravenously. The patients were observed for 24 h for PONV, pain, side-effects and need for rescue antiemetic medication. RESULTS: No significant differences in the incidence of PONV or need for rescue antiemetic treatment was observed in the 0-24 h postoperative study period. The overall incidence of PONV was 43% in the ondansetron group and 47% in the metoclopramide group. The ondansetronpatients had a significantly higher incidence of moderate or strong pain during the postoperative observation period (61% vs. 35% in the metoclopramide group) (P < 0.05). No significant differences in side-effects between the groups were observed. CONCLUSIONS:Metoclopramide 20 mg i.v. given at the end of laparoscopic cholecystectomy resulted in a similar incidence of PONV compared with ondansetron 8 mg. The patients receiving metoclopramide had less pain than the patients receiving ondansetron.
Authors: H Kehlet; A W Gray; F Bonnet; F Camu; H B J Fischer; R F McCloy; E A M Neugebauer; M M Puig; N Rawal; C J P Simanski Journal: Surg Endosc Date: 2005-08-11 Impact factor: 4.584
Authors: Jan Wallenborn; Götz Gelbrich; Detlef Bulst; Katrin Behrends; Hasso Wallenborn; Andrea Rohrbach; Uwe Krause; Thomas Kühnast; Martin Wiegel; Derk Olthoff Journal: BMJ Date: 2006-07-21