Comparison of Efficacy of Clonidine versus Ondansetron for Prevention of Nausea and Vomiting Post Thyroidectomy: A Double Blind Randomized Controlled Trial

S, Shilpa; Shailaja, S; Hilda, Selvaraj Shanthini

doi:10.7860/jcdr/2015/12721.5866

Cited by 8 publications

(8 citation statements)

References 21 publications

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“…However, there are also published studies which have contradicted these findings 72 , 265 – 268 . Some also reported higher Ramsay sedation scores with clonidine 266 .…”

Section: Perioperative Antiemetic Drugs Used For the Treatment And/ormentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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“…However, there are also published studies which have contradicted these findings 72 , 265 – 268 . Some also reported higher Ramsay sedation scores with clonidine 266 .…”

Section: Perioperative Antiemetic Drugs Used For the Treatment And/ormentioning

confidence: 99%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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“…Shilpa et al published a double-blind, randomized controlled trial comparing the efficacy of clonidine versus ondansetron ( 25 ). This prospective study randomly assigned 60 patients with an ASA score of I or II into an ondansetron group or a clonidine group ( 25 ). Those in the ondansetron group received 8 mg of oral ondansetron, while the clonidine group received 150 μg of clonidine as premedication.…”

Section: Discussionmentioning

confidence: 99%

“…Both groups received 8 mg of dexamethasone intravenously. A larger percentage of patients in the clonidine group developed PONV than in the ondansetron group (36.7 versus 30%) ( 25 ). For the patients who experienced nausea and vomiting, those in the clonidine group experienced it during the 1–2 h postoperative period and those in the ondansetron during the 6–12 h postoperative period ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…A larger percentage of patients in the clonidine group developed PONV than in the ondansetron group (36.7 versus 30%) ( 25 ). For the patients who experienced nausea and vomiting, those in the clonidine group experienced it during the 1–2 h postoperative period and those in the ondansetron during the 6–12 h postoperative period ( 25 ). Therefore, the study concluded that ondansetron with dexamethasone is more effective in controlling PONV when compared with clonidine with dexamethasone ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…For the patients who experienced nausea and vomiting, those in the clonidine group experienced it during the 1–2 h postoperative period and those in the ondansetron during the 6–12 h postoperative period ( 25 ). Therefore, the study concluded that ondansetron with dexamethasone is more effective in controlling PONV when compared with clonidine with dexamethasone ( 25 ). Nonetheless, in our study, 36.2% of the patients in the ondansetron group experienced PONV.…”

Section: Discussionmentioning

confidence: 99%

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A Prospective, Randomized, Double-Blinded, Double-Dummy Pilot Study to Assess the Preemptive Effect of Triple Therapy with Aprepitant, Dexamethasone, and Promethazine versus Ondansetron, Dexamethasone, and Promethazine on Reducing the Incidence of Postoper

et al. 2016

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IntroductionPostoperative nausea and vomiting (PONV) is among the most common distressing complications of surgery under anesthesia. Previous studies have demonstrated that patients who undergo craniotomy have incidences of nausea and vomiting as high as 50–70%. The main purpose of this pilot study is to assess the incidence of PONV by using two different prophylactic regimens in subjects undergoing a craniotomy. Thus, we designed this study to assess the efficacy and safety of triple therapy with the combination of dexamethasone, promethazine, and aprepitant versus ondansetron to reduce the incidence of PONV in patients undergoing craniotomy.Materials and methodsThis is a prospective, single center, two-armed, randomized, double-dummy, double-blind, pilot study. Subjects were randomly assigned to one of the two treatment groups. Subjects received 40 mg of aprepitant pill (or matching placebo pill) 30–60 min before induction of anesthesia and 4 mg of ondansetron IV (or 2 ml of placebo saline solution) at induction of anesthesia. In addition, all subjects received 25 mg of promethazine IV and 10 mg of dexamethasone IV at induction of anesthesia. Assessments of PONV commenced for the first 24 h after surgery and were subsequently assessed for up to 5 days.ResultsThe overall incidence of PONV during the first 24 h after surgery was 31.0% (n = 15) in the aprepitant group and 36.2% (n = 17) for the ondansetron group. The median times to first emetic and significant nausea episodes were 7.6 (2.9, 48.7) and 14.3 (4.4, 30.7) hours, respectively, for the aprepitant group and 6.0 (2.2, 29.5) and 9.6 (0.7, 35.2) hours, respectively, for the ondansetron group. There were no statistically significant differences between these groups. No adverse events directly related to study medications were found.ConclusionThis pilot study showed similar effectiveness when comparing the two PONV prophylaxis regimens. Our data showed that both treatments could be effective regimens to prevent PONV in patients undergoing craniotomy under general anesthesia. Future trials testing new PONV prophylaxis regimens in this surgical population should be performed to gain a better understanding of how to best provide prophylactic treatment.

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Review of clinical pharmacokinetics and pharmacodynamics of clonidine as an adjunct to opioids in palliative care

Amna,

Øhlenschlæger,

Sædder

et al. 2024

Basic Clin Pharma Tox

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Clonidine is an α‐adrenoceptor agonist acting on receptors in the brain and peripheral tissues, leading to a reduction in sympathetic outflow and release of certain neurotransmitters. Clonidine has multiple uses across various medical conditions. One of its uses is as adjuvant to anaesthetic and analgesic agents specially opioids, mostly administered through intravenous and epidural routes. The opioids, effective in cancer pain management, are associated with various side effects such as sedation, pruritus, constipation, nausea, respiratory depression, tolerance and dependence. Combination of clonidine with opioids seems to help to achieve better pain management and less need of opioids. Use of clonidine in palliative care has been less common, but it is gradually gaining recognition for its potential benefits in managing symptoms like cancer pain and agitation. This combination approach has been explored in palliative care settings, including cancer pain and agitation, where patients experience complex and refractory symptoms. It seems to be well tolerated and gives better symptom relief. The available literature on clonidine's use in cancer pain and agitation management, especially in subcutaneous form, is limited and outdated. Therefore, the optimal dosing, safety profile and overall effectiveness of subcutaneous clonidine requires further exploration through prospective research studies.

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Comparison of Efficacy of Clonidine versus Ondansetron for Prevention of Nausea and Vomiting Post Thyroidectomy: A Double Blind Randomized Controlled Trial

Cited by 8 publications

References 21 publications

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

A Prospective, Randomized, Double-Blinded, Double-Dummy Pilot Study to Assess the Preemptive Effect of Triple Therapy with Aprepitant, Dexamethasone, and Promethazine versus Ondansetron, Dexamethasone, and Promethazine on Reducing the Incidence of Postoper

Review of clinical pharmacokinetics and pharmacodynamics of clonidine as an adjunct to opioids in palliative care

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