Control Of Postoperative Nausea And Vomiting Research Articles

Study of the effect of timing of pre-operative administration of dexamethasone and ondansetron on post-operative nausea and vomiting follow laparoscopic cholecystectomy: A prospective randomized control trial

: Post-operative nausea and vomiting (PONV) is potential complication in patients after laparoscopic cholecystectomy. The incidence rate of PONV after laparoscopic cholecystectomy (LC) is 46-75% which is higher than that after other types of surgery. The present study was aimed to compare the effect of timing of dexamethasone and ondansetron alone when given 45 minutes before induction or given just before induction of anaesthesia for control of PONV in laparoscopic cholecystectomy. : Tocompare the effect of timing of dexamethasone and ondansetron each when given 45 minutes before induction or given just before induction for control of PONV in laparoscopic cholecystectomy.: After approval by the institutional ethics committee, this study was carried out on 200 patients of both sexes in the age group of 20-60 years. It was a randomized controlled trial. And after obtaining the consent, the patients were allocated in four groups randomly. Group A: 8 mg dexamethasone 45 minutes before induction, Group B: 4 mg ondansetron 45 minutes before induction, Group C: 8 mg dexamethasone just before induction and Group D:4 mg ondansetron just before induction. Patients were observed for 24 hours after surgery for any episode of nausea and vomiting for 24 hours. Patient satisfaction with the management of PONV symptoms using 10 points verbal rating scale was accessed (VRS, 0=not satisfied, 10 = fully satisfied).: Incidence of nausea and vomiting was significantly higher in group B was 68% and D 50% in comparison to group A 28%and C 36% (P=0.003). PONV score was highly significant when ondansetron was administered 45 minutes before induction as compare to dexamethasone when administered 45minutes before induction. The effect of ondansetron was also significant in PONV score of 24 hrs in comparison to dexamethasone.: The ondansetron appears to have a shorter duration of action in comparison to dexamethasone. Timing of administration of ondansetron is important in laparoscopic cholecystectomy before surgery as it has bearing on the incidence of vomiting and rescue antiemetic required. It was found that administration of ondansetron just before induction still delays the onset of PONV in comparison to when given 45 minutes before induction.

Ginger (Zingiber officinale Roscoe) preparations for prophylaxis of postoperative nausea and vomiting: A Bayesian network meta-analysis

Ethnopharmacological relevanceGinger has been proposed for prevention of postoperative nausea and vomiting (PONV), however it remains equivocal whether ginger can be an alternative option and which certain preparation is optimal for PONV prophylaxis. Aim of the studyWe conducted a network meta-analysis (NMA) to compare and rank relative efficacy for PONV control among all available ginger preparations collected in the databases. MethodsEligible records were identified by retrieving Medline (via Pubmed), Embase, Web of Science, CENTRAL, CNKI, WHO ICTRP and ClinicalTrials.gov for randomized controlled trials that investigated the efficacy of ginger therapies for the prophylaxis of PONV. A bayesian NMA within random-effects models was implemented. Certainty of evidence for estimates was investigated following GRADE framework. We prospectively registered the protocol (CRD 42021246073) in PROSPERO. ResultsEighteen publications comprising 2199 participants with PONV were identified. Ginger oil (RR [95%CI], 0.39 [0.16, 0.96]) appeared to have the highest probability of being ranked best to decrease the incidence of postoperative vomiting (POV), with statistical significance compared with placebo, based on high to moderate confidence in estimates. With regard to reducing postoperative nausea (PON), statistically superiority was not observed in ginger regimens compared with placebo based on moderate to low certainty of evidence. Reduction in antemetic use and nausea intensity were noticed in ginger powder and oil. Ginger was significantly associated with better efficacy for Asian, older age, higher dosage, preoperative administration, hepatobiliary and gastrointestinal surgery. ConclusionsGinger oil appeared to be superior to other ginger treatments for the prophylaxis of POV. With regard to reducing PON, ginger preparations indicated no obvious advantages.

Decreasing Inpatient Opioid Use Following Orthognathic Surgery.

Strategies to decrease postoperative opioid use are important for mitigating the immediate and long-term risks associated with their use. We aimed to investigate the impact of perioperative various factors on inpatient opioid needs for patients undergoing orthognathic surgery. This was a retrospective cohort study of all patients who underwent orthognathic surgery performed by the senior author from 2012 to 2018. Patients were grouped into intravenous (IV) acetaminophen and no-IV acetaminophen cohorts. Opioid medications received by patients during hospital stay were converted to mean morphine equivalents (MME) for comparison. Additional factors that influenced opioid consumption, such as transexamic acid (TXA) and postoperative nausea and vomiting (PONV), were identified using univariate analysis. Factors found to have statistical significance were added to a multivariate linear regression model. 319 patients were included. Those who received IV acetaminophen had lower rates of total opioid use (57.3 versus 74.8 MME; P = 0.002) and postoperative opioid use (24.0 versus 37.7 MME; P < 0.001). Perioperative prothrombotic agents, such as TXA, were associated with lower total and postoperative MME (P = 0.005, P = 0.002). Multivariate regression analysis showed that increased PONV resulted in increased postoperative opioid use, whereas perioperative acetaminophen lowered total and postoperative quantities. Perioperative IV acetaminophen is an effective method for decreasing inpatient opioid analgesia after orthognathic surgery. Intravenous TXA and PONV control may provide additional benefit to decreasing inpatient opioid consumption. More research as to the mechanisms and ideal clinical applications for both IV acetaminophen and TXA are warranted.

Effect of palonosetron, ondansetron and dexamethasone in the prevention of postoperative nausea and vomiting in video cholecystectomy with total venous anesthesia with propofol-remifentanil – randomized clinical trial

Introduction and objectivesThe incidence of Postoperative Nausea and Vomiting (PONV) after video cholecystectomy is high. Progress in pharmacological PONV prophylaxis includes a new generation of 5-HT3 antagonists. This study aims to assess the effect of the 5-HT3 antagonist in postanesthetic antiemetic management of patients submitted to laparoscopic cholecystectomy with total intravenous anesthesia. MethodsSixty individuals who underwent video cholecystectomy were randomized into three groups of 20 individuals according to the treatment administered: 0.125 mg of palonosetron (Group 1); 4 mg of ondansetron associated with 4 mg of dexamethasone (Group 2); 4 mg of dexamethasone (Group 3). General intravenous anesthesia was performed with propofol, remifentanil and rocuronium. The group to which the participant belonged was concealed from the investigator who assessed drug effect. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. Rescue medication was 0.655 to 1.5 mg of droperidol. ResultsGroup 1 presented a lower incidence of PONV and required less rescue medication in the first postoperative hour. There was no significant difference among the three groups regarding PONV incidence in the first 12 postoperative hours. Groups 1 and 2 were superior to Group 3 regarding the control of PONV from 12 to 24 hours, and after rescue medication from 12 to 24 hours. Group 1 showed significantly superior nausea control in the first 12 postoperative hours. ConclusionsThe present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea.

Efeito da palonosetrona, ondansetrona e dexametasona na prevenção de náusea e vômito pós‐operatório em videocolecistectomia com anestesia venosa total com propofol‐remifentanil – ensaio clínico randomizado duplo cego

Introduction and objectivesThe incidence of Postoperative Nausea and Vomiting (PONV) after video cholecystectomy is high. Progress in pharmacological PONV prophylaxis includes a new generation of 5‐HT3 antagonists. This study aims to assess the effect of the 5‐HT3 antagonist in postanesthetic antiemetic management of patients submitted to laparoscopic cholecystectomy with total intravenous anesthesia. MethodsSixty individuals who underwent video cholecystectomy were randomized into three groups of 20 individuals according to the treatment administered: 0.125 mg of palonosetron (Group 1); 4 mg of ondansetron associated with 4 mg of dexamethasone (Group 2); 4 mg of dexamethasone (Group 3). General intravenous anesthesia was performed with propofol, remifentanil and rocuronium. The group to which the participant belonged was concealed from the investigator who assessed drug effect. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. Rescue medication was 0.655 to 1.5 mg of droperidol. ResultsGroup 1 presented a lower incidence of PONV and required less rescue medication in the first postoperative hour. There was no significant difference among the three groups regarding PONV incidence in the first 12 postoperative hours. Groups 1 and 2 were superior to Group 3 regarding the control of PONV from 12 to 24 hours, and after rescue medication from 12 to 24 hours. Group 1 showed significantly superior nausea control in the first 12 postoperative hours. ConclusionsThe present study showed evidence that palonosetron is superior to the drugs compared regarding a protracted antiemetic effect and less requirement of rescue drugs, mainly related to its ability to completely inhibit the uncomfortable symptom of nausea.

Comparison of ondansetron HCl, granisetron HCl and palanosetron HCl for prevention of postoperative nausea and vomiting following gynaecological surgery under general anaesthesia

Context: Postoperative Nausea and Vomiting (PONV) is associated with many adverse events, which prolong and increase the healthcare cost. Aims: To compare the efficacy of Palanosetron with respect to Granisetron and Ondansetron in prevention of PONV. To study the need of rescue antiemetic and incidence of side effects. Settings and Design: This Prospective, Randomized study was carried out with 150 adult female patients of ASA Grade I & II posted for elective gynecological surgery under GA. Materials and Methods: Patients were divided into three groups of 50 patients each. Group O received injection ondansetron 8 mg IV, Group G received Granisetron 2.5 mg IV & Group P received Palanosetron 0.075 mg iv before GA induction. Episodes of nausea, vomiting, need for rescue antiemetic and side effects were observed for 72 hours in postoperative period. Statistical Analysis Used: Graphpad Software with consideration of significant P value Results: Incidence of nausea and vomiting was more with Ondansetron and minimal with Palanosetron with statistical significance of P Lowest incidence of nausea was found with Palanosetron during 3-24 hours postoperatively (P Complete Control of PONV (No PONV, No rescue drug required) was maximum in P group in all hours of study [P Conclusion: Palanosetron is safe, well tolerated and effective than Granisetron and Ondansetron in reducing the incidence of PONV with less need of rescue antiemetics. Key Messages: Palanosetron is proved better antiemetic than granisetron and ondansetron in prevention of PONV. Keywords: General Anaesthesia, Granisetron, Gynaecological surgery, Ondansetron, Palanosetron, Postoperative nausea and vomiting.

Comparing the efficacy of aprepitant and ondansetron for the prevention of postoperative nausea and vomiting (PONV): A double blinded, randomised control trial in patients undergoing breast and thyroid surgeries.

Background and Aims:Aprepitant, a Neurokinin-1 receptor antagonist, has been evaluated in abdominal and neurosurgeries, but its effect is less clear in breast and thyroid surgeries, which are also known to be high risk for post-operative nausea and vomiting (PONV). This study was done to compare the antiemetic efficacy of ondansetron and aprepitant in women undergoing mastectomy and thyroidectomy.Methods:One hundred and twenty-five ASA I and II, female patients, aged between 18 and 65 years were randomly assigned into Group I (ondansetron group, n = 62) or Group II (aprepitant group, n = 63), by computer-generated random sequencing. Per protocol analysis was done to assess the incidence and severity of PONV, use of rescue antiemetics, and patient satisfaction with PONV control between the two groups, till 24 h post-surgery.Results:In the immediate postoperative period, 79.7% of patients in Group I and 85.2% in Group II were free of emesis (P value: 0.49). In Group I, the first episode of vomiting occurred within a median duration 90 min (IQR 2575: 45-147) postoperatively, whereas the median duration in Group II was 160 min (IQR 25-75: 26-490), with request for rescue antiemetic at 60 min in Group I (IQR 25-75: 27-360) and 147 min in Group II (IQR 25-75: 11-457).Conclusion:A single dose of oral aprepitant has comparable effects to injection ondansetron administered eighth hourly in preventing PONV, the severity of nausea, number of rescue antiemetics, and the time to first emetic episode in the 24-h postoperative period.CTRI Reg No:REF/2017/06/014637.

Control of Postoperative Nausea and Vomiting in Oral and Maxillofacial Surgery Patients with Isopropyl Alcohol: A Prospective Randomized Clinical Trial.

The present study was undertaken to evaluate the effectiveness of inhaled 70% isopropyl alcohol (IPA) in controlling postoperative nausea and vomiting (PONV) in oral and maxillofacial surgery patients undergoing surgery under general anesthesia (GA). This was a prospective, randomized, case-controlled study done on 208 maxillofacial surgery patients operated under GA. Patient's demographic data, APFEL score for risk of PONV, duration of surgery and duration of anesthesia were recorded preoperatively. The test arm of the study received inhalation of 70% IPA every half an hour in the postoperative period for 8h along with ondansetron 4mg i.v. every 6h. The control arm received only ondansetron 4mg i.v. every 6h. Both the groups followed the same preoperative and postoperative instruction and drug protocol except the test drug. PONV was recorded using the simplified PONV intensity score and VAS. The scores were analyzed with Mann-Whitney test with <0.05 considered significant. The groups were similar with regard to age (p=0.083), BMI (p=0.1.00), sex (p=0.379), type of surgery (p=0.504), duration of anesthesia (p=0.621), duration of surgery (p=0.515) and APFEL score (p=0.687). IPA inhalation group achieved significantly better simplified PONV scores and VAS scores at 4h (p=0.000), 6h (p=0.000) and 8h (p=0.000). PONV control at 2h was similar to the control group. Inhalation of 70% IPA every half an hour was associated with significant PONV control in maxillofacial surgery patients undergoing surgery under GA.

Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial

The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV). This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.

Betahistine as an add-on: The magic bullet for postoperative nausea, vomiting and dizziness after middle ear surgery?

Purpose:Patients undergoing middle ear surgery experience variable degrees of postoperative nausea and vomiting (PONV) despite prophylaxis and treatment with ondansetron or other 5HT3 receptor antagonists. Furthermore vertigo or dizziness are not well controlled perioperatively. Role of betahistine was tested as an add-on to ondansetron in control of PONV and vertigo in middle ear surgery cases.Materials and Methods:We conducted a prospective, randomized, double-blind, placebo controlled study, enrolling one hundred patients undergoing middle ear surgery under local anesthesia into two groups consisting of fifty (n = 50) patients each. Group A patients were given betahistine 16 mg plus ondansetron 8 mg and placebo plus ondansetron 8 mg were given to group B or placebo group, orally 3 hours before starting operation. The incidence of nausea, vomiting, and dizziness was noted during the intraoperative and postoperative 24 hours period. Chi-square test, unpaired ‘t’ test, and Fisher’s exact tests were performed for statistical analysis using SPSS version 16 and Open Epi version 2.3.1 softwares.Results:Complete response was obtained in 90% patients in the betahistine group as compared to 66% in the placebo group. Vomiting in the intraoperative and postoperative period was noted in 4% and 8% cases, respectively, in the betahistine group as compared to 18% and 26%, respectively, in the placebo group. Overall, vertigo was 10% versus 32% in betahistine group and placebo group, respectively.Conclusion:Betahistine as an add-on to ondansetron can significantly attenuate PONV and perioperative vertigo, following middle ear surgeries.

Effect of Acupuncture on Nausea and/or Vomiting During and After Cesarean Section in Comparison With Ondansetron

Acupuncture has been used for the management of postoperative nausea and vomiting (PONV). This study compared the effect of electrical acustimulation with ondansetron for preventing intraoperative and postoperative emetic symptoms and improving patient satisfaction. After gaining ethical approval, 450 parturients scheduled for elective cesarean delivery were randomly allocated to receive either electrical stimulation using P6 acupoint (pericardium 6) bilaterally for 30 min before spinal anesthesia (group III; n = 150), or 4 mg ondansetron 30 min before spinal anesthesia (group II; n = 150), or placebo (group II; n = 150). Nausea and vomiting were evaluated and recorded intraoperatively and postoperative for 24 h by an independent anesthetist. The three groups were not significantly different with respect to intraoperative ephedrine dose and duration of surgery. Nausea and vomiting occurred statistically significantly less often in the active treatment groups (II, III) during operation and for 6 h postoperatively. There was no statistically significant difference between the groups in the incidence of nausea and vomiting from 6 to 24 h postoperatively. Patient satisfaction with PONV control was higher with the active treatment groups compared with group I. Electrical acustimulation is comparable to ondansetron in prevention of PONV during and after cesarean delivery under spinal anesthesia and in improving patient satisfaction.

Postoperative Nausea and Vomiting

Postoperative Nausea and Vomiting

Effect of acupuncture on nausea and/or vomiting during and after cesarean section in comparison with ondansetron

Acupuncture has been used for the management of postoperative nausea and vomiting (PONV). This study compared the effect of electrical acustimulation with ondansetron for preventing intraoperative and postoperative emetic symptoms and improving patient satisfaction. After gaining ethical approval, 450 parturients scheduled for elective cesarean delivery were randomly allocated to receive either electrical stimulation using P6 acupoint (pericardium 6) bilaterally for 30min before spinal anesthesia (group III; n=150), or 4mg ondansetron 30min before spinal anesthesia (group II; n=150), or placebo (group II; n=150). Nausea and vomiting were evaluated and recorded intraoperatively and postoperative for 24h by an independent anesthetist. The three groups were not significantly different with respect to intraoperative ephedrine dose and duration of surgery. Nausea and vomiting occurred statistically significantly less often in the active treatment groups (II, III) during operation and for 6h postoperatively. There was no statistically significant difference between the groups in the incidence of nausea and vomiting from 6 to 24h postoperatively. Patient satisfaction with PONV control was higher with the active treatment groups compared with group I. Electrical acustimulation is comparable to ondansetron in prevention of PONV during and after cesarean delivery under spinal anesthesia and in improving patient satisfaction.

Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%. Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery. Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours. Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01). Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.

Prévention et traitement des nausées et vomissements postopératoires chez l'enfant : une approche basée sur les preuves

Significant improvement towards an efficacious control of postoperative nausea and vomiting (PONV) has taken place recently. These improvements may be summarised using the « rule of three ». That rule describes a pragmatic and rational approach of PONV control. First, identify the patient at risk using predictive factors. Second, modify the anaesthesia technique to keep the baseline risk as low as possible. Third, administer antiemetics rationally, considering their degree of efficacy, their risk, and their potential additive effects. Despite considerable research efforts, identifying the patient at high risk of PONV remains a difficult task. However, today, we understand the degree of efficacy, dose-responsiveness, and adverse effects of most antiemetics. None of those molecules should be regarded as being universally efficacious, there is no gold standard, and, when used alone, their degree of efficacy is limited. Thus, they should be combined for improved efficacy. Among the most promising molecules are butyrophenones (droperidol, haloperidol), 5-HT 3 receptor antagonists (ondansetron, dolasetron, tropisetron, granisetron), and steroids (for instance, dexamethasone). The lack of relevant paediatric PONV data remains a major drawback and is highly unsatisfactory. Hopefully, future research will further improve the control of PONV not only in adults but also in children.

Therapeutic Options for the Prevention and Treatment of Postoperative Nausea and Vomiting

Even with the development of the serotonin 5-HT(3) receptor antagonists in recent years, postoperative nausea and vomiting (PONV) remains a significant concern for clinicians and patients. For the selection of an appropriate antiemetic strategy for PONV, economic considerations should be taken into account. A literature search covering the period from September 1996 to August 2005 yielded 16 economic evaluations on antiemetics used for the prevention or treatment of PONV. In these studies, a variety of different antiemetic regimens were evaluated, with different doses and timing of administration, in many different populations, for various types of surgery, and in different settings. In addition, there were many differences in the design of these economic evaluations in terms of the extent of the costs considered and the decision rules used when forming conclusions. Therefore, despite the availability of economic evaluations on antiemetics in PONV, it is difficult to draw clear conclusions with such disparate information. In spite of these limitations, key learning can be drawn from these economic evaluations. From studies where a placebo was used as a comparator, we can conclude that there is clinical benefit in using an antiemetic for the prevention of PONV versus no therapy. The dose of the 5-HT(3) receptor antagonist seems more important in determining cost effectiveness than the selection of the agent itself, and less expensive agents such as droperidol, dexamethasone and prochlorperazine may also represent cost-effective alternatives to 5-HT(3) receptor antagonists. In an additional six studies where a willingness to pay (WTP) to avoid or reduce the incidence of PONV was estimated, the average WTP amounts varied from $US29 to $US117. Many questions remain unanswered about the cost effectiveness of existing antiemetics and their regimens, and little is known about the impact of new agents, such as the neurokinin-1 receptor antagonists, in the control of PONV.

The Utility of Antiemetics in the Prevention and Treatment of Postoperative Nausea and Vomiting in Patients Scheduled for Laparoscopic Cholecystectomy

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence after laparoscopic cholecystectomy. Numerous antiemetics have been studied for the prevention and treatment of PONV in patients scheduled for laparoscopic cholecystectomy. Traditional antiemetics, including anticholinergics (e.g., scopolamine), antihistamines (e.g., dimenhydrinate), phenothiazines (e.g., promethazine), butyrophenones (e.g., droperidol), and benzamide (e.g., metoclopramide), are used for the control of PONV. The available nontraditional antiemetics for the prophylaxis against PONV are dexamethasone and propofol. Serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron), compared with traditional antiemetics, are highly efficacious for PONV. The prophylactic ondansetron, granisetron, tropisetron, and dolasetron in antiemetic efficacy are comparable. Ramosetron is effective for the long-term prevention of PONV. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. Combination antiemetic therapy is often effective for the prevention of PONV following laparoscopic cholecystectomy. The efficacy of a combination of serotonin receptor antagonists (ondansetron and granisetron) and droperidol is superior to monotherapy with a serotonin receptor antagonist or droperidol. Similarly, adding dexamethasone to ondansetron or granisetron improves antiemetic efficacy in PONV. Knowledge regarding antiemetics is necessary to completely prevent and treatment of PONV in patients scheduled for laparoscopic cholecystectomy.

Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: A systematic review of randomized controlled trials.

Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: A systematic review of randomized controlled trials.

Comparison of the Antiemetic Efficacy of Droperidol, Granisetron, and Propofol after Epidural Morphine

Background: We compared the antiemetic efficacy of droperidol, granisetron, and propofol in postoperative nausea and vomiting (PONV) in the patients who received epidural anesthesia with bupivacaine and morphine. Methods: Among one hundred and sixty one ASA physical status I or II patients who received an abdominal hysterectomy under epidural anesthesia, sixty patients who showed PONV and thereby received antiemetics were randomly assigned into 3 groups: droperidol 0.75 mg (droperidol group: n = 20), granisetron 1.0 mg (granisetron group: n = 20) or propofol 20 mg (propofol group: n = 20) by an intravenous injection. Antiemetics were injected according to the patient request up to 3 times of initial dose. Nausea, vomiting, sedation, anxiety, and discomfort were assessed and the time interval between each antiemetic administration was recorded by a blind observer for 30 min after the injection of antiemetics. Results: Success rates in PONV control for 30 min after the 1st antiemetic administration were 90%, 95%, and 85% in the droperidol, granisetron, and propofol group, respectively. The propofol group experienced a higher relapse incidence (90%) than other groups (droperidol: 35%, granisetron: 25%)(P 501 min: P

Efficacy of repeat intravenous dosing of ondansetron in controlling postoperative nausea and vomiting: a randomized, double-blind, placebo-controlled multicenter trial

Study Objectives: To compare repeat intravenous (IV) dosing of ondansetron 4 mg with placebo for the treatment of postoperative nausea and vomiting (PONV) in patients for whom prophylactic, preoperative ondansetron 4 mg IV was inadequate Design: Randomized, double-blind, placebo-controlled study. Setting: Ten outpatient surgical centers in the United States. Patients: 2,199 male and female ASA physical status I, II, and III patients ≥12 years old scheduled to undergo outpatient surgical procedures and receive nitrous oxide-based general anesthesia. Interventions: Ondansetron 4 mg IV was administered to all patients before induction of general anesthesia. Patients who experienced PONV or requested antiemetic therapy within 2 hours after discontinuation of inhaled anesthesia were randomized (1:1) to either a repeat IV ondansetron 4 mg dose or placebo. Measurements and Main Results: Of the 2,199 patients prophylactically treated with ondansetron 4 mg before anesthesia induction, 1,771 (80.5%) did not experience PONV or request antiemetic therapy during the 2 hours following discontinuation of anesthesia. Of the 428 patients who experienced PONV or requested antiemetic therapy during the same period, and were randomized to additional treatment (214 randomized to ondansetron, 214 randomized to placebo), the incidence of complete response (no emesis, no rescue medication, no study withdrawal) was similar for both ondansetron-randomized and placebo-randomized groups for the 2-hour (34% and 43%, respectively, p = 0.074) and 24-hour (28% and 32%, respectively, p = 0.342) postrandomization study periods. Repeat ondansetron dosing was not more effective than placebo in controlling either postoperative emesis or the severity/duration of postoperative nausea. The administration of an additional dose of ondansetron 4 mg postoperatively did not result in an increased incidence of adverse effects. Conclusions: In patients for whom preoperative prophylaxis with ondansetron 4 mg IV is not successful, a repeat dose of ondansetron 4 mg IV in the postanesthesia care unit does not appear to offer additional control of PONV.