Assessment of ondansetron and droperidol for the prevention of post-operative nausea and vomiting after cholecystectomy and minor gynaecological surgery performed by laparoscopy

Abstract

The anti-emetic effects of ondansetron and droperidol were evaluated in 134 ASA Grade I and II female patients, scheduled for laparoscopic cholecystectomy and minor gynaecological laparoscopic surgery, who were randomly assigned to receive ondansetron 4 mg or droperidol 75 micrograms kg-1 intravenously immediately after induction of anaesthesia. The patients were assessed 1, 6, 12 and 24 h after surgery for intensity of nausea and number of vomiting episodes. In the case of the patients undergoing laparoscopy, vomiting episodes occurred in a similar proportion in patients treated with ondansetron or droperidol, with the probability of the Type I error of 0.05 and the Type error II of 0.1. Although there was no difference between the two groups in emetic episodes following all laparoscopic procedures and gynaecological laparoscopic surgery, there was a significant difference between these parameters after laparoscopic cholecystectomy. The patients treated with ondansetron experienced a lower intensity of nausea (P = 0.04) after laparoscopic cholecystectomy, less frequent severe nausea (P = 0.02) and episodes of vomiting (P = 0.04) when compared with those in the droperidol group. We conclude, that despite the result the droperidol prophylaxis appears to be an effective alternative to ondansetron in all patients undergoing laparoscopy, the ondansetron prophylaxis is superior to droperidol in patients undergoing laparoscopic cholecystectomy.

The Utility of Antiemetics in the Prevention and Treatment of Postoperative Nausea and Vomiting in Patients Scheduled for Laparoscopic Cholecystectomy

“…Serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron) are highly efficacious for PONV following laparoscopic cholecystectomy [7,17,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Their actions involve both central and peripheral mechanisms in the control of nausea and vomiting.…”

“…Several investigations compared the prophylactic antiemetic efficacy of ondansetron with other commonly used and well-established antiemetics (e.g., droperidol and metoclopramide) in patients scheduled for laparoscopic cholecystectomy, and showed that preoperative prophylactic i.v. administration of ondansetron 4 mg was superior to droperidol 1.25 mg (75 µg/kg) or metoclopramide 10 mg [6,16,29,30]. However, Steinbrook et al reported that droperidol 0.625 mg plus metoclopramide 10 mg was more effective than ondansetron 4 mg for the prevention of PONV [31].…”

“…Headache is the most commonly reported adverse event in clinical trials of serotonin receptor antagonists for PONV after laparoscopic cholecystectomy. Other known side effects include abdonimal pain, constipation, and elevated liver enzyme [7,17,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Extrapyramidal reactions have been reported in patients receiving ondansetron performed under general anesthesia [77,78].…”

Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

“…6 In the presence of prophylactic antiemetics, the frequency decreased, but remained significant, within a range of 30% to 60% depending on the type of study. [7][8][9] Female gender, history of motion sickness or PONV, and a negative smoking history are also risk factors for PONV. 1,3 In general, these characteristics are not amenable to modification in the preoperative setting.…”

Ondansetron-droperidol combination vs. ondansetron or droperidol monotherapy in the prevention of postoperative nausea and vomiting

“…Droperidol [ 8 ], a butyrophenone dopamine receptor antagonist, and ondansetron [ 9 , 10 ], a selective 5-hydroxytryptamine type-3 (5-HT3) receptor antagonist, are two widely used antiemetics in anesthesia that exhibit some efficacy in the prevention of PONV [ 11 – 14 ]. Over the decades, droperidol has been proven to be a highly effective antiemetic, without side effects such as arrhythmias, sedation, extrapyramidal symptoms and dizziness, especially with doses higher than 1.25 mg [ 8 , 15 ].…”