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Background: Postoperative nausea and vomiting (PONV) are most common and distressing complications after anaesthesia and surgery, leading to various problems. Metoclopramide, a benzamide, used as an anti-emetic, has got various side-effects. Propofol, a short acting induction agent, possesses anti-emetic properties in sub hypnotic doses, without having unwanted side- effects in this low dose. Objectives: To compare the frequency of PONV in patients treated with propofol and metoclopramide. Study Design: Experimental study. Setting: Department of anaesthesia and intensive care, Combined Military Hospital Rawalpindi. Duration: 06 months (01st July to 31st December 2004). Materials and Methods: 182 female patients scheduled for open cholecystectomy were selected for this study. All of them received general anaesthesia without any prophylactic antiemetic. Out of them, 60 patients who complained of PONV in post anaesthesia care unit (PACU) were selected by non probability convenience sampling and were equally divided into two groups. Group ‘A’ received propofol (0.5 mg/kg) while group ‘B’ received metoclopramide (0.2 mg/kg). Recurrence of PONV was recorded 60 min after administration of the study drug. Patients still complaining of PONV 30 min after administration of the study drug received a rescue medication i.e. I/V ondansetron (4mg). Results: In group “A”,18 patients responded to intervention (60%) whereas 26 (86.66%) patients gave a positive response in group “B” (p 0.020). More patients who received propofol needed the rescue medication (40%) than those who received metoclopramide (13.33%) (p 0.020). Conclusion: Metoclopramide is a better option for managing PONV than propofol.Keywords:
Metoclopramide
Ondansetron
Source Citation Egerton-Warburton D, Meek R, Mee MJ, Braitberg G. Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo. Ann Emerg Med. 2014 May 9. [Epub ahead of print] 24818542
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Peri-operative nausea and vomiting (PONV), remain a considerable problem. Ondansetron is being promoted currently as the drug of choice for the prevention and treatment of PONV. Experiments to investigate efficacy of ondansetron in PONV have been made with placebo or single doses of other drugs, e.g. metoclopramide, and often with different anaesthetic regimes with different emetic potential. This study investigated the relative benefits, in the prevention of PONV, of ondansetron compared with metoclopramide used at a dose higher than used in previous studies. Ninety-six patients undergoing minor gynaecological surgery were randomized to receive either ondansetron 4 mg or metoclopramide 0.4 mg kg-1. The patients were then assessed in the recovery room, in the day ward prior to discharge and the following day for the occurrence of PONV. Emetic symptoms occurred in similar proportions of patients who received ondansetron and metoclopramide. Nausea scores were similar between the groups in the recovery ward and 24-h follow-ups but there were higher post-operative nausea scores in the ondansetron group in the day ward (P = 0.001). There were no significant side effects due to either drug. We conclude that moderate dose metoclopramide is an effective alternative to ondansetron in the control of PONV.
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PURPOSE The role of 5-HT3 receptor antagonists in the prevention of chemotherapy-induced delayed emesis is controversial. We compared ondansetron and metoclopramide, both combined with dexamethasone, in cisplatin-treated patients. PATIENTS AND METHODS Three hundred twenty-two patients who had been given > or = 50 mg/m2 of cisplatin were randomly assigned to receive, from days 2 to 4 after chemotherapy, oral ondansetron (8 mg twice daily) or oral metoclopramide (20 mg every 6 hours), both associated with intramuscular dexamethasone (8 mg twice on days 2 and 3, and 4 mg twice on day 4). Patients received the same intravenous prophylaxis for acute emesis: ondansetron 8 mg and dexamethasone 20 mg. Nausea and vomiting were assessed daily until day 6 after chemotherapy. RESULTS According to the intention-to-treat principle, 318 patients were assessable. Known prognostic factors were similar in the two treatment groups. Complete protection from delayed vomiting and nausea was achieved by 62.0% and 43.7% of patients treated with ondansetron and by 60.0% and 53.7% of those receiving metoclopramide (no significant differences). Patients who vomited in the first 24 hours achieved the lowest complete protection from delayed emesis. In these patients, ondansetron offered better complete protection from vomiting than metoclopramide (28.6% v 3.8%, P < .05). Both treatments were well tolerated. CONCLUSION The two treatments offer similar protection from delayed emesis, although ondansetron plus dexamethasone may be preferred in patients who suffer from acute vomiting. Optimal control of acute emesis is essential to achieve good protection from delayed nausea and vomiting, irrespective of the antiemetic treatment received.
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Peri-operative nausea and vomiting (PONV), remain a considerable problem. Ondansetron is being promoted currently as the drug of choice for the prevention and treatment of PONV. Experiments to investigate efficacy of ondansetron in PONV have been made with placebo or single doses of other drugs, e.g. metoclopramide, and often with different anaesthetic regimes with different emetic potential. This study investigated the relative benefits, in the prevention of PONV, of ondansetron compared with metoclopramide used at a dose higher than used in previous studies. Ninety-six patients undergoing minor gynaecological surgery were randomized to receive either ondansetron 4 mg or metoclopramide 0.4 mg kg−1. The patients were then assessed in the recovery room, in the day ward prior to discharge and the following day for the occurrence of PONV. Emetic symptoms occurred in similar proportions of patients who received ondansetron and metoclopramide. Nausea scores were similar between the groups in the recovery ward and 24-h follow-ups but there were higher post-operative nausea scores in the ondansetron group in the day ward (P=0.001). There were no significant side effects due to either drug. We conclude that moderate dose metoclopramide is an effective alternative to ondansetron in the control of PONV.
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Ondansetron
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ABSTRACT Background Postoperative nausea and vomiting (PONV) may prolong patient recovery time and increase the cost of their care. Ondansetron is an effective treatment for PONV, but is more expensive than other antiemetics. The Auckland District Health Board (ADHB) PONV guidelines are a stepwise approach to anti‐emetic prescribing in which ondansetron is the last choice. Aim To investigate the patterns of ondansetron prescribing in the management of PONV at Auckland City Hospital and whether its use was in accordance with the ADHB PONV guidelines. Method A retrospective drug use evaluation of patients for whom ondansetron was prescribed, and who were admitted postoperatively to 20 adult medical and surgical wards. Results 303 patients were recruited over a 4‐week period, of whom 256 surgical patients were considered. Adherence with the ADHB PONV guidelines was higher when a reminder (an antiemetic sticker) was used than when it was not used (84% vs 76%). Use of the sticker increased the proportion of patients for whom other anti‐emetics were prescribed. There was poor identification of patients at risk of PONV and consequently limited use of prophylactic antiemetics in this group. Conclusion Although the use of antiemetic stickers was low, overall adherence to the ADHB PONV guidelines was encouraging. A number of steps were often omitted when an antiemetic sticker was not used and a significant proportion of patients received ondansetron first‐line.
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The antiemetic effect of ondansetron (Supplied by Qi Lu Pharmaceutical Company) in cisplatin-induced nausea and vomiting was studied in a randomized cross-over trial in 167 patients. The daily dose of cisplatin was 30mg for 5 days, 50mg for 3 days or 50mg/m2 for 1-2 days. The patients received randomly ondansetron, metoclopramide or Zofran (Glaxo) in the first cycle of the treatment and received the other antiemetic drug in the second cycle. The effective control rate of acute emesis (0-2 emetic episodes) was 86.6% in patients treated with ondansetron and 35.4% in those treated with metoclopramide. The mean frequency of vomiting was 1.1 times in ondansetron and 5.7 times in metoclopramide (P < 0.01). The results show that ondansetron (Qi Lu) is superior to metoclopramide for the control of acute or delayed emesis. The antiemetic effects of ondansetron (Qi Lu) and Zofram (Glaxo) are similar. The side-effects of ondansetron are mild.
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Objective To compare the efficacies of different combinations of ondansetron,metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting(PONV)in patients undergoing oral and maxillofacial surgery.Methods Nine hundreds and seventy sevenⅠ-Ⅱpatients(American Society of Anesthesiologists[ASA])undergoing oral and maxillofacial surgery,aged from 20 to 75 years old,were inclu- ded in the present study.All patients received general anesthesia and patient-controlled intravenous analgesia (PCIA).Antiemetic formula were randomly divided into 3 groups.Group A..metoclopramide 30 mg;group B: ondansetron 4 mg+metoclopramide 30 mg;group C:ondansetron 4 mg+dexamethasone 5 mg+metoclo- pramide 30 mg.Results The incidences of PONV in group C(1.1%)was significantly lower than those of group A(41.9%)and B(18.8%),and that of group B was significantly lower than that of group A(P0.05).The rate of severe vomiting was 63.60% in group A,31.0% in group I3 and none in group C.Conclusion Ondansetron combined with dexamethasone or metroiopramide has strong antiemetic effect in treatment of PONV.
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The objective of this study was to compare, by means of meta-analysis, the postoperative antiemetic efficacy of ondansetron in patients with and without antecedents of postoperative nausea and vomiting.MEDLINE and EMBASE databases were searched for randomised placebo-controlled trials which evaluated the antiemetic effectiveness of 4 mg and 8 mg intravenous doses of prophylactic ondansetron in adult patients. A further selection was with respect to those studies which noted the patient's previous history of postoperative nausea and vomiting (PH-PONV) and, for the meta-analysis, the patients were divided into two sub-groups: those with (PH-PONV +) and those without a previous history of postoperative nausea and vomiting (PH-PONV -). Absence of vomiting was used as the index of effectiveness.Twenty-one trials involving 3984 patients (2446 in ondansetron groups and 1538 in placebo groups; 1163 PH-PONV(+) patients and 2821 PH-PONV(-) patients) met the selection criteria. The effectiveness of the 4 mg dose of ondansetron was: OR (95% CI)=2.40 (1.77-3.26) vs. 2.71 (2.23-3.30) for the patients of PH-PONV(+) and PH-PONV(-) sub-groups, respectively. For the 8 mg dose, the effectiveness of ondansetron was: PH-PONV(+)=4.21 (2.66-6.66) and PH-PONV(-)=2.61 (1.81-3.59). For neither of the doses evaluated was there any significant statistical difference between the sub-groups.The effectiveness of ondansetron in the prevention of postoperative vomiting is not affected by the patients' PH-PONV.
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