International, multicentre, placebo-controlled study to evaluate the effectiveness of ondansetron vs. metoclopramide in the prevention of post-operative nausea and vomiting

Abstract

Ondansetron 4 mg was compared with metoclopramide 10 mg for prevention of post-operative nausea and emesis in in-patients undergoing major gynaecological surgery in this double-blind, randomized, placebo-controlled, multicentre study. A total of 1044 patients received a single intravenous (i.v.) injection of study medication immediately before induction of anaesthesia. Nausea and emesis were assessed over the 24 h post-operative period. Significantly more patients who received ondansetron experienced no emetic episodes (44%) compared with those who received metoclopramide (37%, P = 0.049) or placebo (25%, P < 0.001). No nausea was experienced by significantly more patients who received ondansetron (32%) than with patients who received metoclopramide (24%, P = 0.009) or placebo (16%, P < 0.001). In addition, fewer emetic episodes, less severe nausea and a reduced need for rescue antiemetics were also observed with ondansetron (P < 0.05 vs. metoclopramide and placebo). Metoclopramide and placebo-treated patients were also 1.5 times (95% Cl 1.5-4.2) and 2.5 times (95% Cl 1.1-2.0) more likely, respectively, to experience nausea post-operatively. Overall, ondansetron was the most effective antiemetic in this patient population.

Postoperative nausea and vomiting in women following breast surgery: an audit

“…As mentioned above, the anaesthetists involved in the care of these patients were unaware of the study and therefore continued their regular practice of antiemetic prescription. Some studies [4] have shown no difference in PONV with perioperative prochlorperazine versus placebo (13% and 14%, respectively) whereas others show a benefit with perioperative antiemetic [3]. It has been suggested that those subsets of patients at high risk of PONV such as women undergoing gynaecological surgery should be given a prophylactic antiemetic.…”

“…Its overall incidence is 15-35% [1][2][3] and varies according to patient, anaesthetic and surgical factors. Most studies on PONV in women are based on gynaecological surgery which is known to be associated with a high incidence of PONV of up to 81% [4,5]. It has been noted on routine postoperative pain assessment ward rounds in this hospital that many women following breast surgery complain of nausea and vomiting.…”

Prophylactic ondansetron for postoperative emesis.Meta‐analysis of its effectiveness in patients with previous history of postoperative nausea and vomiting

“…The data referring to the effectiveness of ondansetron in the two sub-groups of patients (with respect to the PH-PONV) were obtained directly from the original in 8 studies (8,9,15,17,(23)(24)(25)27), and in the rest of the studies from correspondence with the authors or study sponsors.…”

Management of Postoperative Nausea and Vomiting in Women Undergoing Major Gynecological Surgery: A Review and Update

“…Prophylactic ondansetron administered i.v or orally has been evaluated in the prevention of PONV [22][23][24][25][26][27][28][29][30][31][32]. In a randomized, double-blind, placebo-controlled trial, ondansetron 4-8 mg administered i.v.…”

“…immediately after induction of anesthesia, in the prevention of PONV [28]. Similarly, Morris et al [29] and Krobbuaban et al [30] compared the efficacy of ondansetron 4 mg and metoclopramide 10 mg, administered i.v. immdeiately before induction of anesthesia.…”