A comparison of cyclizine and granisetron alone and in combination for the prevention of postoperative nausea and vomiting

Abstract

SummaryWe conducted a randomised double-blinded study of 960 women undergoing day-case surgery to determine whether combination anti-emetic therapy of granisetron and cyclizine was more effective at decreasing the incidence of postoperative nausea and vomiting than these agents used alone. The women were randomly allocated to three groups to receive intravenous granisetron 1 mg, cyclizine 50 mg or both before induction of general anaesthesia. The incidence of postoperative nausea and vomiting was 77 ⁄ 322 (24%) in the granisetron group, 73 ⁄ 316 (23%) in the cyclizine group and 53 ⁄ 322 (17%) in those women given both drugs (p = 0.04). There was no difference in the requirement for rescue anti-emetic drugs. There were no differences in the anaesthetic techniques used in the three groups. We conclude that the risk of postoperative nausea and vomiting is less with cyclizine and granisetron given together than with either given alone. Postoperative nausea and vomiting (PONV) is still a frequent complication of anaesthesia and surgery, with 8-45% of day-case patients and up to 70% of patients undergoing gynaecological laparoscopic procedures suffering this distressing complication. This is understandably of major concern to patients [1, 2]. Some patients report that it is of greater concern to them than postoperative pain [3][4][5]. The aetiology of PONV is still not clearly understood but is known to be multifactorial. Postoperative nausea and vomiting can delay discharge from postanaesthesia care and has been shown to be a major cause of unplanned admission to hospital after day-case surgery, with a corresponding increase in the costs of patient care [6][7][8][9][10]. With government targets of 75% of patients being treated on a day-stay basis, it is becoming increasingly important that this complication of anaesthesia is treated effectively, not only to improve patient satisfaction but also to allow for the efficient use of available facilities.It is widely accepted that it is not cost-effective to treat all patients prophylactically with anti-emetics, and that to do so exposes patients to the added risk of unwanted sideeffects [11]. However, there is little agreement on what is an appropriate approach to this problem. Postoperative nausea and vomiting is often managed with a single prophylactic anti-emetic given during surgery, but there is a growing trend towards the use of combination antiemetic therapy in moderate to high-risk patients. The optimal combination is yet to be universally agreed.We conducted a prospective, randomised, blinded study of three groups of day-case gynaecology women prophylactically treated with granisetron, cyclizine or a combination of both to determine the efficacy of these drugs given separately and in combination. MethodsWith Local Research Ethics Committee approval and written, informed patient consent, we recruited 960 adult women who were scheduled to undergo day-case gynaecological surgery. Women who were pregnant, breast feeding or who had a known allergy to one of the drugs ...

Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies

“…4 Several previous studies have demonstrated that combination antiemetics were superior to individual drugs for the prophylactic prevention of PONV. [17][18][19][20][21] The results from this study are consistent with the previous findings. Johns et al demonstrated that the use of granisetron 1 mg iv and cyclizine 50 mg iv was associated with a higher efficacy compared with an individual antiemetic in patients undergoing ambulatory surgery.…”

“…The study was also limited to a 24-h collection of postoperative data, and the anesthetic regimen was not standardized. 19 The dosing of antiemetics used in this study was lower than previous studies. Granisetron 0.35 mg iv has been demonstrated to provide good antiemetic coverage.…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…Similarly, the combination of droperidol and ondansetron was additive (Chan et al, 2006 Level I). Other combinations that were more effective than either drug given alone were cyclizine and granisteron (Johns et al, 2006 Level II), dexamethasone and haloperidol (Rusch et al, 2007 Level II; Chu CC et al, 2008 Level II), and dexamethasone and dolasetron (Rusch et al, 2007 Level II). The addition of metoclopramide to dexamethasone also led to better PONV prophylaxis but, compared with dexamethasone 8 mg alone, only if doses of 25 mg and 50 mg metoclopramide were used and not 10 mg (Wallenborn et al, 2006 Level II).…”

Management of Postoperative Nausea and Vomiting in Women Undergoing Major Gynecological Surgery: A Review and Update

“…Cyclizine is an inexpensive antiemetic drug [79]. Walder et al compared the efficacy of cyclizine 50 mg and droperidol 1.25 mg, given i.v.…”