Double‐blind comparative study of droperidol, granisetron and granisetron plus dexamethasone as prophylactic anti‐emetic therapy in patients undergoing abdominal, gynaecological, breast or otolaryngological surgery

Abstract

SummaryIn this double-blind study the clinical efficacy of a single pre-operative intravenous dose of droperidol 1.25 mg (137 patients), granisetron 1 mg (130 patients) and granisetron 1 mg plus dexamethasone 5 mg (130 patients) was investigated for the prevention of postoperative nausea and vomiting after gynaecological surgery, breast surgery, abdominal surgery and ear, nose and throat surgery. The incidence of nausea in the first 24 h postoperatively was 52% in the droperidol group, 48% in the granisetron group and 34% with the combination, respectively. Both granisetron and granisetron/dexamethasone performed better than droperidol in their effects on vomiting or combined nausea and vomiting (incidence in the first 24 h 22%, 18% and 42%, respectively). The number of emetic episodes during the 5-day study period was significantly higher in the droperidol group (198) than in the granisetron (73) Nausea and vomiting are unpleasant consequences of general anaesthesia. The cause of postoperative nausea and vomiting (PONV) is multifactorial. Several patientrelated factors may affect the incidence of PONV, such as age, gender, weight, motion-sickness and the extent of pre-operative anxiety. Anaesthesia-related factors include the experience of the anaesthetist, premedication, anaesthetic agent (propofol), use of opioids and technique of anaesthesia. The highest incidence of PONV is found in abdominal surgery, gynaecological surgery, laparoscopic surgery, ear nose and throat surgery and breast reductions.

EFFICACY OF GRANISETRON AND GRANISETRON PLUS DEXAMETHASONE AS PRE - EMPTIVE ANTI - EMETIC THERAPY FOR PONV IN PATIENTS UNDERGOING GENERAL ANESTHE SIA FOR ABDOMINAL SURGERY : A CONTROLLED, PROSPECTIVE & RANDOMIZED STUDY

“…In present study, the incidence of PONV was 16 %, 20% and 76% (p<.001) and the complete response was found to be 84%, 80% and 24% (p<.001) in group G+D, group G and control group respectively. This is very well comparable to 82% and 78% response found in the combination and granisetron alone group respectively in a study done by Janknegt et al [14] A similar study was undertaken by Fujii et al, [15] to evaluate the efficacy of granisetron alone and its combination with dexamethasone for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy. In a prospective study, 120 patients received granisetron 40g/kg or granisetron and dexamethasone 8 mg (n=60 each) intravenously, immediately before induction of anaesthesia.…”

Randomized, Placebo-Controlled Trial of Granisetron for Control of Nausea and Vomiting During Cesarean Delivery Under Spinal Anesthesia

“…Granisetron is a selective 5-HT 3 receptor antagonist and has more potent and longer-acting properties than ondansetron for the treatment of cisplatin-induced emesis [3]. Recently, granisetron has been found to have a prophylactic antiemetic effect on PONV in patients undergoing surgery under general anesthesia [4]. So far, there is a scarcity of data for other 5-HT 3 antagonist (granisetron, dolosetrone, and tropisetron) in the Indian context, and limited data on the granisetron in association with spinal anesthesia for preventing PONV in cesarean delivery.…”

Prophylaxe von postoperativer Übelkeit und postoperativem Erbrechen

“…Dies erstaunt umso mehr, da in den bisher publizierten Studien für Dexamethason sowohl als Monotherapeutikum als auch in Kombination mit anderen Antiemetika -ein antiemetischer Effekt nachgewiesen werden konnte [11]. Studien, die die Effektivität einer PONV-Prävention mit Dexamethason in Kombination mit einem 5-HT 3 -Antagonisten nachweisen, liegen für Ondansetron, Granisetron und Tropisetron vor [11,15,16,17,28,30,31]. In diesem Zusammenhang muss darauf hingewiesen werden, dass die meisten Studien zu Granisetron von Fujii et al publiziert wurden, an deren Ergebnissen erhebliche Zweifel geäußert wurden (zit.…”

“…Auch Thomas u. Jones fanden nur innerhalb der ersten 3 h eine signifikante PONVReduktion in der Kombinationsgruppe, während sich über den gesamten Beobachtungszeitraum kein signifikanter Unterschied feststellen ließ [31]. In ihrer Studie, die sich mit der Kombination von Tropisetron mit Dexamethason (0,5 mg/kg) befasst, konnten Holt et al eine signifikante Verringerung von PONV in der Kombinationsgruppe zeigen [16], während Janknegt et al dies für Granisetron mit 5 mg Dexamethason nicht nachweisen konnten [17]. In der bisher einzigen Publikation, die die Effektivität der Kombination von Dolasetron und Dexamethason (4 mg) untersuchte, fanden Coloma et al bei Patienten, die sich einer laparokopischen Cholezystektomie unterzogen, eine signifikante Reduktion der PONV-Inzidenz durch Kombination der beiden Medikamente im Vergleich zur Monotherapie mit Dolasetron, jedoch keine signifikanten Unterschiede in der Erbrechensinzidenz [9].…”