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.
Résumé
Objectif
Les nausées et vomissements postopératoires (NVP) sont des effets secondaires pénibles de l’anesthésie générale. L’objectif de cette étude était de comparer l’activité antiémétique de différents antagonistes des récepteurs de la 5-hydroxytryptamine avec celle de la métoclopramide et d’un placebo.
Méthode
Au cours d’une étude randomisée, prospective et en double aveugle, les auteurs ont comparé l’effet antiémétique procuré par l’administration préventive d’ondanestron 4 mg, de tropisetron 5 mg et de granisetron 3 mg avec celle de la métoclopramide 10 mg et d’un placebo chez 132 patients opérés pour une cholécystectomie par laparoscopie. Tous les médicaments à l’étude de même que le placebo ont été administrés par perfusion iv 10 min avant l’induction. La prise en charge anesthésique périopératoire a été standardisée chez tous les sujets. Les nausées et vomissements ont été évalués par l’interrogatoire personnel du patient à 1, 4, 9, 12, 18 et 24 h après le réveil. Lorsque les patients avaient des nausées et/ou des vomissements, un antiémétique de sauvetage (métoclopramide 10 mg iv) était administré.
Résultats
Pour une période de 24 h après l’intervention, le pourcentage de patients sans complication émétique a été respectivement de 65,5%, 52%, 48%, 29,2% et 27,6% pour le groupe ondansetron, granisetron, tropisetron, mêtoclopramide et placebo. L’ondansetron administré préventivement a produit une incidence plus faible (P = 0,02) de NVP que la métoclopramide et le placebo. Le délai précédant l’administration de l’antiémétique de sauvetage a été plus long (P < 0,01) dans le groupe ondansetron que dans les groupes métoclopramide et placebo. Il n’y a eu aune différence entre les groupes ondanestron, tropisetron et granisetron.
Conclusion
L’ondanestron administré préventivement a produit une incidence plus faible de NVP que la métoclopramide et le placebo. La métoclopramide n ’a pas été efficace.
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Naguib, M., Bakry, A.K.E., Khoshim, M.H.B. et al. Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 43, 226–231 (1996). https://doi.org/10.1007/BF03011739
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DOI: https://doi.org/10.1007/BF03011739