Comparison of oral olanzapine versus oral ondansetron for prevention of postoperative nausea and vomiting in female patients undergoing laparoscopic cholecystectomy under general anaesthesia

Abstract

Introduction: Postoperative nausea and vomiting is one of the significant problem in anaesthesia practice The incidence is even high following laparoscopic surgeries. 5HT3 receptor antagonists are routinely used to prevent postoperative nausea and vomiting (PONV). Olanzapine, an atypical antipsychotic drug with its activity on multiple receptor sites particularly at D2 and 5HT3 receptors, has potential antiemetic properties. This study aimed to compare the efficacy of ondansetron with olanzapine in prevention of PONV following laparoscopic cholesystectomy under general anaesthesia. Materials and methods: This randomized double blind controlled study was done by recruiting 120 female patients belonging to ASA I/II posted for laparoscopic cholecystectomy under general anaesthesia. Patients were assigned to one of the two groups. Group A received tablet Olanzapine 5mg, 4 hrs before surgery and Group B received tablet ondansetron 16mg 1hr before surgery. Postoperatively nausea, retching, vomiting complete response and sedation were assessed for 24hrs at the interval of 0-4hrs, 4-8hrs, 8-12hrs and 12-24hrs. Results: There was no statistical difference in the incidence of postoperative nausea, retching and vomiting between the groups at 0-4hrs, 4-8hrs. Statistical difference between the groups were seen at 8-12hr interval (nausea p=0.048, retching=0.042, vomiting p=0.042) and at 12-24 hr (nausea p=0.028, retching p=0.001, vomiting p=0.006). There was a significant difference in the use of rescue drug at 8-12hrs (6.7% patients required rescue drug in Group B whereas none required in Group B). Conclusion: Olanzapine 5 mg can be used safely and effectively for prophylaxis against PONV and is more effective in preventing PONV during the late postoperative period compared to ondansetron.