The Comparison Effect of Preoperative Ondansetron and Metoclopramide in Reducing Nausea and Vomitting after Loparoscopic Cholecystectomy

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1 Journal of Ardabil University of Medical Sciences Vol.3, No.2, Summer 203, Pages The Comparison Effect of Preoperative Ondansetron and Metoclopramide in Reducing Nausea and Vomitting after Loparoscopic Cholecystectomy Entezariasl M, Isazadehfar Kh* 2, Noorani Z 3 Departmnt of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran 2 School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran 3 General Practitioner, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran *Corresponding Author. Tel: Fax: Received: 2 Nov 202 Accepted: 8 May 203 ABSTRACT Background & Objectives: Postoperative nausea and vomiting (PONV) is one of the most common complications of anesthesia and without prophylactic intervention occurs in about one-third of patients under general anesthesia. The aim of this study was to compare the efficacy of ondansetron and metoclopramide in reducing PONV after laparoscopic cholecystectomy. Methods: In this study, 90 patients undergoing laparoscopic cholecystectomy were randomly allocated into three equal groups (n=30) and in the first group 0 mg metoclopramide, in the second group 4 mg ondansetron and for placebo group 2 cc normal saline preoperatively were injected. Anesthesia complications in recovery and nausea and vomiting in recovery and 6 hours and 24 hours after surgery were evaluated. Data were analyzed by SPSS software with chi-square test and analysis of variance (ANOVA). P<0.05 was considered significant. Results: The incidence of nausea in placebo group was 66.7 %, in metoclopramide group was 43.3 % and in ondansetron group was 33.3 %. The difference only between placebo and ondansetron groups was significant (p=0.09). The incidence of vomiting in placebo group was 56.7%, in metoclopramide group was 20% and in ondansetron group was 26.7% and there was significant difference between placebo and ondansetron groups (p=0.035) and between placebo and metoclopramide groups (p=0.007), whereas there was not any significant difference between intervention groups (p=0.2). Also anti-emetic drug administration in ondansetron group (40%) in comparison with metoclopramide (63.3%) and placebo (66.7%) was lower, but this difference was not statistically significant (p= 0.07). Conclusion: For prevention of vomiting after laparoscopic cholecystectomy, both metoclopramide and ondansetron are effective. In comparing these two drugs, in preventing of nausea ondansetron is more effective than metoclopramide, whereas there was not any significant difference between two drugs in preventing of vomiting. Key words: Ondansetron; Metoclopramide; Laparoscopic Cholecystectomy; PONV

2 * : :. * : cc : 4 mg 0mg 6. spss /05 P.. %33/3 %43/3 %66/7 :.( P =0/09) %26/7 %20 %56/7 (P=0/035) (P =0/007).(P =0/2) (%66/7) (%63/3) (%40).( P=0/07) :.. : 92/2/28 : ( 60 0 ) : 9/8/2 :.[]

3 57....[4].[5] : :.[4]..[6] IRCT N3 90..[2].. (motion sickness).[]... ) -5 ( ) (.[3] (CTZ)

4 392 ) (. (Shivering) mg. %40 ( %40 %70) 30 β=%20 α=0/05. 8 SPSS ( ANOVA) 0/05...( ) II I ASA. : BMI 2 > (M) (O). (P) 2 2 mg. 2 0/5 µg/kg mg/kg 2 mg/kg 00 µg/kg/min. 0/25 mg/kg.. 6 l/min %00 0/05 mg/kg 0/025 mg/kg. American Society of Anesthesiologists 2 Body Mass Index

5 59... F /2 0/49 2/ /86 /72 /3 Chi 2 /78 2/03 6/92 6/05 4/97 8/78 23/03 4/4 4/4 9/02 /86 7/45 P-value 0/77 0/3 0/69 0/27 0/56 0/ 0/4 0/7 0/28 P-value 0/003 0/6 0/03 0/003 0/00 0/028 0/00 0/35 0/02 0/03 0/006 0/076 (n=30) 5 (6/7) 25 (86/3) 42/7 ± 4/027 72/33 ± 0/62 2 (70) 9 (30) 2 (6/6) 77 ± 6/2 26/ ± 4/28 77/93 ± 9/02 85/53 ±2/93 (n=30) 2(40) (3/3) 6(20) 20(66/7) 7(56/7) 6(53/3) 0(33/3) 2(6/7) 7(23/3) 20(66/7) 7(56/7) 20(66/7) ( ± ) (%). (n=30) 4 (3/3) 26 (86/7) 46/27 ± 5/95 69/97 ± 8/82 23 ( 76/7) 7 (23/3) 3 (0) 79/23 ± 3/42 32/47 ± /45 8/43 ± 9/67 82/20 ± 3/7 (n=30) 9(30) (3/3) 6(20) 3(43/3) 5(6/7) 8(26/7) 3(43/3) 6(20) 9(63/3) (n=30) 7 ( 23/3) 23 (76/7) 45/97± 3/069 72/47 ± 7/9 6 (53/3) 4 (46/7) 5 (6/6) 84/67 ± 6/0 28/5 ± 0/4 77/0 ± 7/2 8/33 ±2/82 () () () (%).2 (n=30) (3/3) 7(23/3) 6(20) 7(23/3) 3(0) 2(6/7) 3(0) 0(33/3) 8(26/7) 2(40) 6 : 6-24 (P=0/007) ( P=0/035) 3 24.( P>0/05) (P=0/003) 6 (P=0/007). (P= 0/00) (P=0/02). 6 (P= 0/00) 24 (P=0/00)..(P= 0/09)

6 392.. [78]. [9] %90 % [0] (%28) (%20) Gupta 2 Kaki 60 (P=0/024). (P=0/024) 6 24 (P=0/033) (P=0/0). (%66/7) (%63/3).(P=0/07) (%6/7) 5 4 (%0) 3 6 (%46/6).(P = 0/06) 6 24.(P =0/66).( P=0/65) (P =0/03) (P =0/0) 90.(P > 0/05)

7 [4] [] [5]..[6] [] 24 (%45 %20).(%20 % 2/5) 2 [2] ).(%22 %8 %4 3 [3] %47 24 %60 4 Yeasmeen 5 Silva 6 Islam Sandhu 2 Wilson 3 Krobbuaban

8 "...[].. References - Islam S, Jain PN. Post-operative nausea and vomiting (PONV): A Review Article. Indian J Anaesth Nov; 48(4): Entezariasl M, Khoshbaten M, Isazadehfar K, Akhavanakbari G. Efficacy of metoclopramide and dexamethasone for postoperative nausea and vomiting: a double-blind clinical trial. East Mediterr Health J. 200 Mar; 6(3): Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth Oct; 47(0): Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J Jul; 44(7): Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth Apr; 5(4): Park A, Lee G, Seagull FJ, Meenaghan N, Dexter D. Patients benefit while surgeons suffer: an impending epidemic. J Am Coll Surg. 200 Mar; 20(3): Sarkar M, Pawar A, Dewoolkar L, Charan S. Comparative study of single dose intravenous ondansetron and metoclopramide as premedication for prevention of postoperative nausea and vomiting in obstetrical laparoscopic surgery under general anesthesia. The Internet Journal of Anaesthesiology. 2007; 3(2). Available from: URL: 8- Okasho Y, Okutani R, Tsujikawa S, Okutani H, Kinishi Y, Oda Y. Incidence of PONV occurrence related to anesthesia and airway management in patients undergoing mastectomy: AP4 5. E J A. 202 June; 29(50): Gupta V, Wakhloo R, Lahori VU, Mahajan MK, Gupta SD. Prophylactic Antiemetic Therapy with Ondansetron, Granisetron and Metoclopramide in Patients Undergoing Laparoscopic Cholecystectomy Under General Anaesthesia. Internet J Anesthesiol. 2007; 4(): 5. Available from: URL: 0- Kaki MA, EL-Hakeem EE. Prophylaxis of postoperative nausea and vomiting with ondansetron, metoclopramide or placebo in total intravenous anesthesia patients undergoing laparoscopic cholecystectomy. Saudi Med J Oct; 29(0): Sandhu T, Tanvatcharaphan P, Cheunjongkolkul V. Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy: a prospective double-blind randomized study. Asian J Surg Apr; 3(2):

9 Wilson EB, Bass CS, Abrameit W, Roberson R, Smith RW. Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy. Am J Surg. 200 Feb; 8(2): Krobbuaban B, Pitakpol S, Diregpoke S. Ondansetron vs. metoclopramide for the prevention of nausea and vomiting after gynecologic surgery. J Med Assoc Thai May; 9(5): Yeasmeen S, Yasmin R, Akhtaruzzaman A, Shahera Khatun U. Intravenous Granisetron, Ondansetron and Metoclopramide in the Prevention and Treatment of Post Operative Nausea and Vomiting after Laparoscopic Cholecystectomy - A Comparative Study. Journal of BSA. 2006; 9(-2): Silva AC, O'Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review. J Oral Maxillofac Surg Sep; 64(9): Kushwaha B, Chakraborty A, Agarwal J, Malick A, Bhushan S, Bhattacharya P. Comparative study of granisetron and ondansetron alone and their combination with dexamethasone, for prevention of PONV in middle ear surgery. Internet J Anesthesiol. 2007; 3(2). Available from: URL: