Retrospective Cohort Study of Granisetron Administration for PONV Prophylaxis and Treatment

Abstract

Postoperative nausea and vomiting (PONV) frequently complicates surgical recovery and is considered to be one of the least desirable surgical side effects. Granisetron (Kytril) 1 mg intravenously (IV) was approved by the FDA for the prevention and treatment of PONV in August 2002. Objective This cohort study evaluated outcomes and utilization associated with granisetron use for PONV prevention and treatment. Methods This was a retrospective cohort study of 400 patient records from 10 US hospitals. Patients included were those greater than or equal to 18 years of age having elective surgery under general anesthesia with granisetron administered IV for prevention or treatment of PONV. Excluded were those with concurrent radiation or chemotherapy, or those observed less than 2 hours in the post anesthesia care unit. Results Mean age was 50 y ± 17 with 272 females (68%). The majority was at moderate-high (n = 230; 58%) or mild-moderate risk of PONV (n = 155; 39%). Granisetron was administered predominantly perioperatively and at 0.1 mg dose (n = 382; 96%) from prefilled syringes extemporaneously prepared from 4 mg/4 mL vials. Total control (absence of nausea and vomiting) was experienced in 330 patients (83%), with 16 (4%) having a vomiting episode. In 167 patients at lower risk of PONV, symptoms were prevented in 148 (less than 90%). Regression analysis indicates that, in addition to absence of key risk factors, combination antiemetic prophylaxis was highly associated with optimal outcome. Granisetron dose did not impact outcome. Conclusion The majority of granisetron use for PONV was prophylactic, administered perioperatively at a 0.1 mg dose. Most patients experienced excellent control, even in the highest risk groups, particularly when granisetron was administered in combination with dexamethasone or metoclopramide.