Comparative Study of Single Dose Intravenous Ondansetron and Metoclopramide as a Premedication for Prevention of Post Operative Nausea and Vomiting in Obstetrical Laparoscopic Surgery under General Anaesthesia

摘要

Post Operative Nausea Vomiting (PONV) is the most unpleasant and distressing consequence in the immediate post-operative period especially after general anesthesia. PONV can delay discharge and may result in unplanned over night hospital admissions. This is prospective randomized control study of 60 ASA grade I/II patients recruited at Seth G.S. Medical College to find out the efficacy, duration of action, haemodynamic stability, side effects of ondansetran and metclopromide lower the incidence of PONV in 24 hr of post operative period. The study was undertaken with an aim to investigate 1) The nausea and vomiting in immediate post operative period. 2) Efficacy of single dose I.V. injection of ondansetran (4mg) and metclopromide on PONV and 3) Side effects of these drugs. Early antiemetic efficacy abolition of vomiting after 1 , 4, 12 hrs was 3.66, 10 and 3.33% respectively from the administration of the study drugs with no further vomiting or nausea episodes after 24 hrs was in the ondansetron group. Similarly, abolition of vomiting after 1 , 4, 12 and 24 hrs was 20, 20 ,16.66 and 3.33 % respectively in the metoclopramide group compared to the placebo group (P < 0.001). This difference was still significant when controlling for age, body weight, history of motion sickness, previous PONV episodes, duration of anesthesia, and intraoperative fentanyl consumption using a logistic model. Therefore the overall results indicated that ondansetran is more effective than metchlopromide for the prevention of PONV. Introduction Pain is not always the patients prime concern in the post operative period, many patients will take nausea and vomiting as the most unpleasant consequence. The number of drugs introduced for the relief of post operative pain have been largely successful but the same cannot be appliable for PONV (Post-operative Nausea and Vomiting).PONV is associated with general anaesthesia (GA) ever since the ether and chloroform era and the reported incidence were reported to be 75-80%. It still remains a problem, despite an evident clinical perception that its severity has diminished with an estimated incidence of 20-50%. PONV has consequence more far reaching than hitherto appreciated. It affects the patients in more ways than one and they may be stated as physical, metabolic, psychological and economic.There are a number of factors influencing the occurrence of PONV which includes Patient factors (Age, gender, obesity, anxiety, history of motion sickness or previous post and vomiting, gastro paresis); Operative procedures; Anesthetic techniques (Drugs for general anesthesia, regional anesthesia and monitored anesthesia care) and Post-operative factors (Pain, dizziness, ambulation, oral in-take, opioids)Laparoscopic surgery is the one condition, where risk of PONV is particularly pronounced. This technique first gained popularity with it use in gynecologic procedures that began in 1970. The patient group in this study was predominantly young. Early ambulation and decreased morbidity due to this technique rendered it increasingly popular. This increases the risk of PONV, which is due to pneumo-peritoneum-causing stimulation of mechanoreceptors in the gut. To reduce the incidence of PONV various pharmacological and non-pharmacological methods have been employed since the advent of anesthesia. Ondansetron is a specific 5 – HT3 subtype receptor antagonist and represents a major improvement in chemotherapy and radiation therapy induced nausea and vomiting. Metoclopramide is a dopamine antagonist acting on the CTZ. It is a gastrointestinal tract (GIT) prokinetic drug. It increases lower esophageal sphincter tone and stimulates motility of the upper GIT. This study endeavors to compare the efficacy of ondansetron and metoclopramide in prevention of PONV when given as a single dose of intravenous (i.v.) premedication in obstetrical laparoscopic surgery under GA. The incidence of side-effects was also noted. Materials and methods Follo