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  • Title: Prophylaxis of postoperative nausea and vomiting with ondansetron, metoclopramide, or placebo in total intravenous anesthesia patients undergoing laparoscopic cholecystectomy.
    Author: Kaki AM, Abd El-Hakeem EE.
    Journal: Saudi Med J; 2008 Oct; 29(10):1408-13. PubMed ID: 18946563.
    Abstract:
    OBJECTIVE: To compare total intravenous anesthesia (TIVA) with ondansetron, and metoclopramide in preventing postoperative nausea and vomiting (PONV) in laparoscopic cholecystectomy patients. METHODS: A prospective randomized double-blinded study was performed at King Abdulaziz University Hospital, Jeddah, Saudi Arabia in 2007. Seventy-five patients scheduled for laparoscopic cholecystectomy under TIVA were randomized to receive either: metoclopramide 10 mg (n=25), 4 mg ondansetron (n=25), or placebo (n=25) at the end of surgery. Postoperative nausea and vomiting episodes, analgesic supply, rescue medication, adverse events, and patient satisfaction were collected over 24 hours. RESULTS: Nineteen patients developed PONV. The frequencies of PONV were equal for the 2 groups (28%), and lower among the ondansetron group (20%) (p>0.05). Female gender, lengthy surgery, and longer hospital stay were associated with more frequent PONV regardless of the study group (p<0.05). Patient's satisfaction was more frequent among the ondansetron group (p>0.05). Morphine consumption was associated with more PONV, but it was statistically significant only in the placebo group. There was no difference between the 3 groups with regard to the VAS pain score, cardiovascular parameters, or oxygen saturation. CONCLUSION: It is unlikely that a single technique or drug will ever be effective in treating emesis under all surgical circumstances. Therefore, a multimodal regimen incorporating avoidance of emesis triggering factors, and administration of antiemetic medications is recommended.
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