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January 1998
Ondansetron vs metoclopramide
in the treatment of postoperative nausea and vomiting.
Polati E, Verlato G, Finko G,
Mosaner W, Grosso S, Gottin L, Pinaroli AM, Ischia S.
Anesth Analg 1997;85:395-9.
[ see abstract below ]
This study sought to compare the efficacy and safety of ondansetron compared with metoclopramide in the treatment of postoperative nausea and vomiting [PONV]. The authors studied 175 patients [51% of 378] who developed PONV during recovery from anesthesia for gynecologic laparoscopy. The standardized anesthetic technique consisted of intramuscular diazepam plus atropine, then thiopental, fentanyl, vecuronium, 60% nitrous oxide and isoflurane as needed.
During recovery, the patients who experienced persistent nausea were randomly assigned to one of the treatment group: ondansetron 4mg, metoclopramide 10mg, or normal saline placebo. The patients were age 34-36 years, body weight 56-58 kg, and duration of anesthesia 79-88 minutes.
The authors looked at early antiemetic efficacy, which was defined as the abolition of vomiting within 10 minutes and abolition of nausea within 30 minutes from administration of the study drug. Early antiemetic efficacy was significantly different in the three groups, occurring in the 93% of patients who received ondansetron, 67% with metoclopramide, and 35% with placebo.
Among the patients who were successfully treated, PONV recurred in 41% with ondansetron, 35% with metoclopramide and 67% with placebo. The timing of recurrence of vomiting was also different. Half of the placebo-treated patients vomited again within 2-3 hours, but sporadic cases of vomiting occurred 6 or more hours later in the ondansetron group but did not occur in the placebo group. One patient in the ondansetron group reported a moderate 3 hour headache requiring treatment with nonsteroidal analgesic drug.
These authors also looked at the role of confounding variables on the 1-hour efficacy of the antiemetic regimens. The only factor for which correlated with increased PONV was the administration of intraoperative fentanyl. Increasing intraoperative fentanyl dose was related with decreased early antiemetic
efficacy, irrespective of the type of antiemetic treatment.
In conclusion, these authors found that ondansetron 4mg was more effective than metoclopramide 10mg which was more effective than placebo in the treatment of established PONV. Early antiemetic efficacy for all treatments was inversely related to the amount of intraoperative fentanyl.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
In this prospective, randomized, double-blind study, we compared the efficacy and safety of ondansetron and metoclopramide in the treatment of postoperative nausea and vomiting (PONV). One hundred seventy-five patients with PONV during recovery from anesthesia for gynecological laparoscopy were treated intravenously with either ondansetron 4mg (58 patients), metoclopramide 10 mg (57 patients), or placebo (60 patients).
Early antiemetic efficacy (abolition of vomiting within 10 min and of nausea within 30 min from the administration of the study drugs with no further vomiting or nausea episodes during the first hour) was obtained in 54 of 58 patients (93.1%) in the ondansetron group, in 38 of 57 patients (66.7%) in the metoclopramide group, and in 21 of 60 patients (35%) in the placebo group (P < 0.001). This difference was still significant when controlling for age, body weight, history of motion sickness, previous PONV episodes, duration of anesthesia, and intraoperative fentanyl consumption using a logistic model.
Early antiemetic efficacy was inversely related to the amount of fentanyl administered during anesthesia, regardless of treatment. According to the Kaplan-Meier method, the probability of remaining PONV-free for 48 h after a successful treatment was 0.59 (95% confidence interval 0,45-0.71) in the ondansetron group, 0.45 (0.29-0.60) in the metoclopramide group, and 0.33 (0.15-0/53) in the placebo group (p = 0.003).
In conclusion, ondansetron 4 mg is more effective than metoclopramide 10 mg and placebo in the treatment of established PONV.
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