Randomized, Double-Blinded Comparison of Tropisetron and Placebo for Prevention of Postoperative Nausea and Vomiting After Supratentorial Craniotomy

Abstract

This prospective, randomized, placebo-controlled, double-blinded study was designed to evaluate the efficacy of tropisetron in preventing postoperative nausea and vomiting after elective supratentorial craniotomy in adult patients. We studied 65 ASA physical status I-III patients aged 18 to 76 years who were undergoing elective craniotomy for resection of various supratentorial tumors. Patients were divided into two groups and received either 2 mg of tropisetron (group T) or saline placebo (group P) intravenously at the time of dural closure. A standard general anesthetic technique was used. Episodes of nausea and vomiting and the need for rescue antiemetic medication were recorded during 24 hours postoperatively. Demographic data, duration of surgery and anesthesia, and sedation scores were comparable in both groups. Nausea occurred in 30% of group T patients and in 46.7% of group P patients (P >.05). The incidence of emetic episodes was 26.7% and 56.7% in the two groups (P <.05). Rescue antiemetic medication was needed in 26.7% and 60% of the patients (P <.05). Administration of a single dose of tropisetron (2 mg intravenously) given at the time of dural closure was effective in reducing postoperative nausea and vomiting after elective craniotomy for supratentorial tumor resection in adult patients.

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

“…8 In addition, the incidence of moderate to severe postcraniotomy pain is 60% to 84%, which is often undertreated in this subset of patients. 9 The commonly used drugs to treat PONV are selective serotonin (5HT 3 ) receptor antagonists, [10][11][12][13] dopaminergic receptor antagonists, 14,15 steroids, 16 and newer agents like the neurokinin-1 (NK-1) receptor antagonist, aprepitant. 17 However, most of these drugs do not have any dual antinociceptive action, and, moreover, the side effects of dopaminergic receptor antagonists may preclude their use in neurosurgical patients.…”

The Efficacy of 5-HT3 Receptor Antagonists for the Prevention of Postoperative Nausea and Vomiting After Craniotomy: A Meta-Analysis

“…13,[29][30][31][32][33] Included studies were all single site with relatively small sample sizes (ranging from 40 to 152 participants). There were 448 patients included in the meta-analysis (222 treatment, 226 control).…”

“…20 for the control groups in a number of these studies could be dexamethasone with the experimental group receiving dexamethasone and a 5-HT 3 receptor antagonist. [29][30][31][32][33] A protective effect for PONV in the control group and/or synergetic effect with the 5-HT 3 receptor antagonists in the treatment group could influence the results of these studies compared to studies that did not use intraoperative dexamethasone.…”

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

“…[1][2][3][4] These studies included patients undergoing craniotomy for various intracranial lesions, but the exact percentage of patients on preoperative steroids was not known. All patients in the current study were on dexamethasone preoperatively.…”