Effect of Prophylactic Ondansetron on Postoperative Nausea and Vomiting in Patients on Preoperative Steroids Undergoing Craniotomy for Supratentorial Tumors

Abstract

The exact incidence of postoperative nausea and vomiting (PONV) in patients on steroids undergoing neurosurgical procedures is not known. This prospective randomized double-blind study was planned to know the efficacy of prophylactic ondansetron in the prevention of PONV in patients on steroids as compared with placebo. Seventy adult patients of either sex who had received preoperative steroids (dexamethasone) for at least 24 hours and were scheduled to undergo craniotomy for supratentorial tumors were included. Patients were randomly allocated using a randomization chart to 1 of the 2 groups to receive either ondansetron 4 mg (group O) or 0.9% saline (group S) intravenously at the time of dural closure. Numeric Rating Scale score for nausea and pain intensity was recorded preoperatively and till 24 hours postoperatively. The 6-hour postoperative nausea score was significantly lower in group O [median, 0; interquartile range (IQR), 0 to 20] than in group S (median, 20; IQR, 0 to 20) (P<0.05). The incidence of vomiting was lower in group O (23%) than in group S (46%) (P<0.05). The total number of emetic episodes, the number of doses of rescue antiemetics given in the first 6 postoperative hours, and the total number of rescue antiemetics given were significantly lower in group O than in group S (P<0.05). Intravenous administration of 4 mg of ondansetron at the time of dural closure was effective in reducing the incidence of PONV and the rescue antiemetics requirement in patients on preoperative steroids undergoing craniotomy for supratentorial tumors.

The Effect of Gabapentin Premedication on Postoperative Nausea, Vomiting, and Pain in Patients on Preoperative Dexamethasone Undergoing Craniotomy for Intracranial Tumors

“…16 Koc¸et al, 20 found that the combination of 800 mg of oral gabapentin and 8 mg of IV dexamethasone administered 1 hour before varicocele surgery provided better PONV and postoperative pain control as compared with placebo or either drug alone. Studies in craniotomy patients have also demonstrated that the combination of dexamethasone with aprepitant (NK-1 receptor antagonist), 17 or ondansetron (5HT 3 receptor antagonist), 21 provides better control of PONV.…”

“…Various studies have shown that a combination of dexamethasone with NK-1 or 5HT 3 receptor antagonists reduces the incidence of PONV after craniotomy. 17,21 Dexamethasone in combination with gabapentin has also been shown to reduce the incidence of postoperative pain in patients undergoing varicocele surgery. 20 The antiemetic effect of gabapentin has not been previously evaluated in patients undergoing craniotomy.…”

Manual de práctica clínica basado en la evidencia: Controles posquirúrgicos

“…Los medicamentos específicos son: dolasetrón (reduce el vómito) [23][24][25][26][27] , granisetrón (reduce el vómito) 28-32 y ondansetrón (reduce el vómito y rescates antieméticos) [28][29][30][33][34][35][36][37][38][39][40][41][42][43][44][45] .…”

A prospective, randomized, double-blind, and multicenter trial of prophylactic effects of ramosetron on postoperative nausea and vomiting (PONV) after craniotomy: comparison with ondansetron

“…However, these agents have been reported to have adverse effects such as excessive sedation, hypotension, dysphoria, hallucinations, and extrapyramidal signs [1,5,12,13], all of which are undesirable for neurological assessment after neurosurgical operations. Selective 5-HT 3 receptor antagonists (ondansetron, granisetron, and tropisetron) are effective in PONV after craniotomy without neurological adverse effects [1,3-5,7,11,14-17]. Ramosetron, a selective 5-HT 3 receptor antagonist, has been used effectively in various surgical procedures for the prevention or treatment of PONV [18].…”