Abstract
Purpose
To evaluate the effects on PONV and headache after tympanoplasty of prochlorperazine 0.2 mg·kg−1 im, ondansetron 0.06 mg·kg−1 iv or placebo (isotonic saline) 0.02 ml·kg−1 iv given immediately after induction of anaesthesia prior to tracheal intubation.
Methods
The study was randomised, double blind and prospective. One hundred and forty-eight patients, aged 9–61 yr, received a standardised balanced inhalational anaesthetic with controlled ventilation and induced hypotension. Postoperatively, the frequencies of retching and vomiting in the PACU and of nausea, retching, vomiting, headache, analgesic and antiemetic requirements in the surgical ward for 24 hr were recorded.
Results
The four test groups (n = 37 each) were comparable. The incidences of vomiting in the PACU were similar. During the first 24 hr after surgery the antiemetics produced no reductions in the incidence of nausea alone or of vomiting alone. However, the combination of nausea and vomiting was reduced from 53% (placebo) to 16% (P < 0.0005), 19% (P < 0.0005) and 30% (P < 0.05) by im. prochlorperazine, iv ondansetron and iv prochlorperazine, respectively. The frequency of those experiencing no PONV was increased from 27% (placebo) by prochlorperazine im to 57% (P < 0.01), by ondansetron iv to 62% (P < 0.005) and by prochlorperazine iv to 43% (P = NS). The. onset of PONV was delayed in those given prochlorperazine im, and vomiting was less severe in those given ondansetron iv. Headache occurred with similar frequency in each group.
Conclusion
Prophylactic prochlorperazine 0.2 mg·kg−1 im and ondansetron 0.06 mg·kg−1 iv are similarly efficacious in reducing nausea with vomiting after tympanoplasty, while prochlorperazine 0.1 mg·kg−1 iv is less efficacious. Neither drug given as described appeared to reduce the frequency of postoperative nausea alone or vomiting alone.
Résumé
Objectif
Évaluer après la tympanoplastie l’effet sur les nausées et vomissements postopératoires (NVPO) de la prochlorpérazine 0,2 mg·kg−1 im, de l’ondansetron 0,06 mg·kg−1 iv ou d’un placebo (soluté isotonique) 0,02 mg·kg−1 iv administrés immédiatement après l’induction de l’anesthésie et avant l’intubation de la trachée.
Méthodes
L’étude était aléatoire, prospective et en double aveugle. Cent quarante-huit patients, âgés de neuf à 61 ans ont reçu une anesthésie équilibrée standardisée avec ventilation contrôlée et hypotension délibérée. En postopératoire, ont été enregistrés, à l’unité des soins postanesthésiques (USPA), la fréquence des efforts pour vomir et les vomissements; pendant 24 h, la fréquence des nausées, des efforts pour vomir, des vomissements, de la céphalée, les analgésiques et antiémétiques requis.
Résultats
Les quatre groupes (n = 37) étaient comparables. L’incidence des vomissements à l’USPA était identique. Pendant les premieres 24 h après la chirurgie, les antiémétiques n’ont modifié ni l’incidence des nausées considérées indépendamment ni celle des vomissements seuls. Cependant, l’association des nausées et de vomissements était réduite de 53% (placebo) à 16% (P < 0,0005), 19% (P < 0,005) et 30% (P < 0,05), respectivement par la prochlorpérazine im, l’ondensetron iv et la prochlorpérazine iv. L’incidence d’absence de NVPO augmentait de 27% (placebo) avec la prochlorpérazine im à 57% (P < 0,01), avec l’ondensetron iv à 62% (P < 0,005) et avec la prochlopérazine iv à 43% (P = NS). L’apparition des NVPO était retardée par la prochlorpérazine im, et les vomissements étaient moins importants avec l’ondensetron iv. Les céphalées survenaient à une fréquence identique dans tous les groupes.
Conclusion
L’administration prophylactique de prochlorpérazine 0,2 mg·kg−1 im et d’ondensetron 0,06 mg·kg−1 iv est également efficace pour réduire les nausées et les vomissements après la tympanoplastie, alors que celle de la prochlorpérazine 0,1 mg·kg−1 iv l’est moins. Aucun des médicaments administrés de la façon décrite réduit les nausées et les vomissements lorsqu ’ils sont considérés indépendamment.
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van den Berg, A.A. A comparison of ondansetron and prochlorperazine for the prevention of nàusea and vomiting after tympanoplasty. Can J Anaesth 43, 939–945 (1996). https://doi.org/10.1007/BF03011808
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DOI: https://doi.org/10.1007/BF03011808