A comparative study of ondansetron and granisetron in combination with dexamethasone-in prophylaxis for postoperative nausea and vomiting (PONV) in laproscopic cholecystectomies

Abstract

INTRODUCTIONPost operative nausea and vomiting (PONV) is the most common and distressing symptom experienced by surgical patients. The incidence of PONV is 20-30 % in general anaesthesia.1,2 The incidence of PONV is 70-80% in females, and more in ocular, middle ear, gynecological surgeries and laproscopic procedures.2 Without antiemetic prophylaxis, the incidence 50-70% in laproscopic cholecystectomies. PONV causes harm to surgical site sutures, anastomoses.3 It increases intraocular, intra-cranial pressure and may also cause tachycardia, electrolyte imbalance, wound dehiscence, oesophageal tears and aspiration pneumonitis. ABSTRACTBackground: Post operative nausea and vomiting (PONV) is a common problem and distressing symptom in surgical patient population. General anaesthesia with inhalational agents is associated with an average PONV incidence of 20-30 % in surgical patients. PONV is difficult to treat and needs multiple drugs and combination of drugs. Granisetron and Ondansetron are among the commonly used 5HT3 antagonists and used in combination with dexamethasone for prophylaxis against PONV. The aim of the study was to compare the efficacy of combination of antiemeticsOndansetron 4mg+Dexamethasone 8mg and Granisetron 1mg+Dexamethasone 8mg in prevention of post operative nausea and vomiting. Methods: 75 patients of ASA 1 and 2 were randomly allocated to three groups-Group 1 (n=25) received Ondansetron 4mg+Dexamethasone 8mg; Group 2 (n=25)-received Granisetron 1mg+Dexamethasone 8mg; Group 3-received saline with dexamethasone 8mg. Standard general anaesthesia protocol was followed. Study drugs were administered at the time of induction. Post operative nausea and vomiting was studied for period of 24hrs. Severity was assessed using PONV Score (0=no nausea;1=nausea only;2=retching;3=vomiting). The adverse effects were also studied. Results: The incidence of PONV was 16% in Group 1 and 2 and 68% in Group 3. The complete response after 24hr period was 32% in control group, 84% in Group 1 and Group 2. Rescue antiemetics were required only in control group. There was no statistical difference noted between Group 1 and Group 2 but there was clinical and statistical significance noted between groups which received prophylactic antiemetic combination and control. Adverse effects were not observed in any group. Conclusions: Granisetron 1mg and Ondansetron 4mg in combination with dexamethasone 8mg are equally effective and safe in decreasing the incidence of post operative nausea and vomiting in laproscopic cholecystectomies under general anaesthesia.

Intravenous Granisetron Combined with Dexamethasone in Cesarean Section Patients Undergoing Spinal Anesthesia

“…Granisetron is used primarily for post-operative nausea and vomiting prophylaxis or treatment, and many previously published studies support our results in this aspect. Nanjundaswamy et al concluded that both granisetron and ondansetron combined with dexamethasone were effective in reducing nausea and vomiting incidences in laparoscopic cholecystectomy surgery patients [20]. Daria and Kumar reported that for patients undergoing gynecologic laparoscopic surgery under general anesthesia, granisetron alone had a lower success rate in the prevention of post-surgery nausea and vomiting compared to a combination of granisetron and dexamethasone [21].…”

A comparative study of granisetrone, dexamethasone and combination of granisetrone-dexamethasone as prophylaxis for postoperative nausea vomiting during laparoscopic surgeries

“…This difference could be because they have not taken APFEL score into consideration which is an important confounding factor in case of PONV and all their patients arefemales. 11 Moussa AA et al, conducted a study on 120 patients undergoing laparoscopic bariatric surgery. Patients were randomized in 4 groups receiving either granisetrone 1 mg, granisetrone 1 mg plus droperidol 1.25 mg, granisetrone 1 mg plus dexamethasone 8 mg or placebo immediately before induction of anaesthesia.…”

Granisetron Versus Ondansetron for Prevention of Post-operative Nausea and Vomiting (PONV) in Patients Undergoing Laparoscopic Cholecystectomy

“…The traditional antiemetics include antihistamines, anticholinergics and dopamine-receptor antagonists [3]. Newer drugs like Serotonin Receptor Antagonists (granisetron and ondansetron) provide better efficacy and safety as compared to the traditional drugs [4]. They bind to the 5-Hydroxytryptamine subtype-3 (5HT3) receptors, selectively blocking the emetogenic stimuli during anesthesia and surgery.…”