Comparison of ondansetron and granisetron for antiemetic prophylaxis in maxillofacial surgery patients receiving general anesthesia: a prospective, randomised, and double blind study

Abstract

ObjectivesTo compare the efficacy of intravenous ondansetron (4 mg, 2 mL) and granisetron (2 mg, 2 mL) for preventing postoperative nausea and vomiting (PONV) in patients during oral and maxillofacial surgical procedures under general anesthesia.Materials and MethodsA prospective, randomized, and double blind clinical study was carried out with 60 patients undergoing oral and maxillofacial surgical procedures under general anesthesia. Patients were divided into two groups of 30 individuals each. Approximately two minutes before induction of general anesthesia, each patient received either 4 mg (2 mL) ondansetron or 2 mg (2 mL) granisetron intravenously in a double blind manner. Balanced anesthetic technique was used for all patients. Patients were assessed for episodes of nausea, retching, vomiting, and the need for rescue antiemetic at intervals of 0-2, 3, 6, 12, and 24 hours after surgery. Incidence of complete response and adverse effects were assessed at 24 hours postoperatively. Data was tabulated and subjected to statistical analysis using the chi-square test, unpaired t-test, or the Mann-Whitney U-test as appropriate. A P-value less than 0.05 was considered statistically significant.ResultsThere was no statistically significant difference between the two groups for incidence of PONV or the need for rescue antiemetic. Both study drugs were well tolerated with minimum adverse effects; the most common adverse effect was headache. The overall incidence of complete response in the granisetron group (86.7%) was significantly higher than the ondansetron group (60.0%).ConclusionGranisetron at an intravenous dose of 2 mg was found to be safe, well tolerated, and more effective by increasing the incidence of complete response compared to 4 mg intravenous ondansetron when used for antiemetic prophylaxis in maxillofacial surgery patients receiving general anesthesia. Benefits of granisetron include high receptor specificity and high potency, which make it a valuable alternative to ondansetron.

Incidence and risk factors for postoperative nausea and vomiting in orthognathic surgery: a 10-year retrospective study

“…This may be one of the reasons for the low incidence of PONV in the first 24 hours after surgery. Though ondansetron is shown to have a good antiemetic effect without many side effects, drugs like granisetron have been seen to have better effects on reducing the incidence of PONV in the first 24 hours after surgery and may be a viable alternative 42 .…”

Extended release granisetron: Review of pharmacologic considerations and clinical role in the perioperative setting

“…[33] Ondansetron is useful as prophylaxis, but granisetron is more potent, longer-acting, making it potentially more useful in those patients with a known PONV history or refractory PONV. [4]…”

“…[25] However, ER granisetron may have unknown effects such as desensitization or rebound phenomena because of its prolonged nature. [4] Further safety and efficacy studies are needed to investigate potential long-term effects.…”

“…Because controversy surrounding data reliability on short-acting granisetron has resolved, it has been useful in treatment of PONV. [123456] In this review, we evaluate recent literature on use of ER granisetron in clinical practice as compared with current antiemetics and describe its potential uses for perioperative PONV prophylaxis and treatment. We performed a literature search of the Medline database (2013 - March 2017).…”

The effect of ondansetron administration 20 minutes prior to spinal anaesthesia on haemodynamic status in patients undergoing elective caesarean section: A comparison between two different doses

“…[ 6 ] Ondansetron has its peak plasma concentration within 30 minutes of intravenous administration when used to treat nausea and vomiting. [ 8 9 10 ] In our presenting clinical trial, we propose that giving ondansetron 20 minutes before performing spinal block should improve the efficacy of counteracting hypotension of spinal block in caesarean section. Our primary aim was to assess systolic blood pressure (SBP), diastolic blood pressure (DBP), and the mean blood pressure (MBP) among different ondansetron doses and a control group in different time intervals.…”