Prevention of Postoperative Nausea and Vomiting in Gynaecological Laparotomies: A Comparison of Tropisetron and Ondansetron

Abstract

In a randomized, double-blind study, the antiemetic efficacy of a single bolus of tropisetron 5 mg (group T, 37 patients), ondansetron 4 mg (group O, 39 patients) or saline (group C, 45 patients) given at induction was compared in a homogeneous group of 121 patients undergoing gynaecological laparotomy and receiving postoperative patientcontrolled intravenous morphine for 24 to 48 hours. Fewer group T and group O patients developed severe nausea compared to group C (P<0.01, log rank test in Kaplan-Meier analysis). Group T patients also had lower nausea scores than group O at 8 to 16h (P<0.05). The overall incidences of severe nausea in groups T, O, and C were 5.4%, 17.9%, and 44.4% respectively (P<0.001, group T vs group C; P<0.05 group O vs group C). In conclusion, the 5-hydroxytryptamine 3 receptor antagonists tropisetron and ondansetron were superior to placebo in preventing PONV.

Comparative safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

“…No statistically significant effects were observed (OR 1.92, 95 % CI 0.30–12.21). Twenty-five studies were excluded from this analysis because they reported zero events in both arms [38, 41, 44, 55, 56, 58, 62, 67, 70, 72, 77, 78, 80, 107, 109, 115, 120, 126, 128, 130, 131, 134, 149, 157, 158]. …”

Tropisetron vs ondansetron for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: A randomized double-blind, placebo-controlled study

“…Comparative studies between dierent 5-HT 3 antagonists for the prevention of PONV in high-risk populations such as patients undergoing otolaryngologic procedures [10], breast surgery [2], or gynecological laparotomies [8,12] fail to show a clear advantage of a speci®c 5-HT 3 antagonist.…”

“…This dierentiation in the time of action of these two drugs in also con®rmed by other studies of the literature. Tsui et al [12] compared the antiemetic ecacy of tropisetron 5 mg, ondansetron 4 mg, or saline in women undergoing laparotomy and they found also that tropisetron was superior to ondansetron between 8 and 16 h postoperatively. The percentage of patients who experienced severe nausea or requested rescue antiemetic throughout the study period was lower in the tropisetron group, but this did not reach statistical signi®cance.…”

Comparison of the Antiemetic Efficacy of Tropisetron and Droperidol with Patient-Given Tramadol

“…5 Tramadol use in the ondansetron group was comparable with that in our tropisetron group, but the vomiting rate in our group was lower, especially after the first 12 h. It is known however, that tropisetron is more effective than ondansetron in preventing PONV. 8 The exact mechanism of action for the combination of 5-HT 3 receptor antagonists and tramadol is not yet known, but may result from drug interaction involving cytochrome P450-2D6 (CYP2D6) oxidation. 12 The analgesic effect of tramadol depends on its opioid effect and inhibition of 5-HT reuptake, and tramadol's analgesic properties are maintained by its M1 metabolites.…”

“…4,5 In contrast, droperidol, a dopamine receptor antagonist, is better than placebo at preventing PONV in patients given tramadol, 6 but the side-effects of droperidol may limit its use in anaesthetic practice. 7 Tropisetron, a potent 5-HT 3 antagonist, is superior to ondansetron in preventing PONV, 8 …”