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SummaryThe effectiveness of ginger (Zingiber ofJicinale) Key wordsSurgery; gynaecological. Vomiting; antiemetics. Nausea and vomiting have long been regarded as some of the most unpleasant sequelae of anaesthesia; effects range from the simply annoying to life threatening electrolyte disturbances and aspiration of stomach contents. There has been no real reduction during the last 50 years in their incidence, which persists at approximately 30%, despite the continued introduction of new antiemetics.' No available antiemetic offers both good pharmacological effectiveness together with an absence of side effects.Recently, there have been reports of the vertigo-reducing effects of ginger root. Mowbrey and Clayson2 found powdered ginger root to have a significantly better effect than placebo or antihistamines, upon experimentally induced motion sickness in volunteers. Grontved and Hentzer' found that ginger root reduced the incidence of induced vertigo significantly more than did placebo in a group of volunteers after calorific stimulation of the vestibular system. There were no reports of nausea in any patient who had received ginger root in this latter study. We therefore postulated that a preparation of ginger root may reduce the incidence of nausea and vomiting after operation and this study was undertaken to investigate the effects of ginger root on postoperative emesis compared with placebo and metaclopramide in patients who have major gynaecological surgery. MethodSixty women who had major gynaecological surgery were included in the study which was approved by the local ethics committee. All patients were ASA grades 1 or 2 and aged between 16 and 65 years. They were informed that the purpose of the study was to compare a commonly used plant derivative, with possible antiemetic properties, with a standard antiemetic or placebo. Written consent was then obtained. Patients who received opioid analgesia or antiemetics 24 hours before surgery were not studied.Capsules were prepared by the pharmacy department at St. Bartholomew's Hospital. The active capsule contained powdered ginger root (Zingiber oficinale) 0.5 g and the placebo capsule lactulose 0.5 g. Both were flavoured with a nonactive chemical essence of ginger. Coloured capsules were used for both to disguise their contents. The capsules were unable to be differentiated when swallowed with 20 ml water. Coded syringes for intravenous injection were prepared freshly by an investigator who did not participate in the anaesthesia or assessment. The active injection contained metoclopramide 10 mg and the placebo injection 2 ml sterile water.Patients were premedicated intramuscularly 1.5 hours before operation with papaveretum and hyoscine: 10 mg and 0.2 mg respectively if bodyweight < 50 kg, 15 mg and 0.3 mg respectively if bodyweight 50-70 kg and 20 mg and 0.4 mg if bodyweight > 70 kg. The study drugs were administered in a double-blind, randomised fashion as follows: Group 1, ginger-root 1 g and placebo injection; Group 2, lactulose 1 g and active injection; ...

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