Comparative Study of the Effectiveness of Ondansetron, Metoclopramide and Low Dose Dexamethasone to Prevent Postoperative Nausea and Vomiting in Females who Undergo Laparoscopic Cholecystectomy

Abstract

<strong>Background:</strong> Despite progress in surgical and anesthetic techniques, postoperative nausea and vomiting are among the most common surgical complications. Prevention and suitable treatment of postoperative nausea and vomiting can decrease the length of hospital stay, hospitalization cost and increase patient satisfaction. <strong>Objectives:</strong> The aim of this study is to assess the effectiveness of three antiemetic drugs in postoperative nausea and vomiting prevention on female patients who undergo laparoscopic cholecystectomies. <strong>Patients and Methods:</strong> This prospective randomized double-blind clinical trial enrolled 126 women, aged 20 to 65 years, who had American Society of Anesthesiologists I and II classifications and were scheduled for elective laparoscopic cholecystectomy. All patients received the same induction and care with propofol-based total intravenous anesthesia. After general anesthesia, patients were randomly divided into four groups: dexamethasone (5 mg; n = 31), ondansetron (4 mg; n = 32), metoclopramide (10 mg; n = 31), and normal saline (n = 32). The patients were assessed for incidence and severity of nausea and vomiting at intervals of 0-1, 1-6, and 6-24 hours after extubation. <strong>Results:</strong> The incidence of nausea was as follows among patients: 72 (20.8%) in the ondansetron group, 23.6% in the dexamethasone group, 25.0% in the metoclopramide group, and 30.5% in the control group. Vomiting was found in 49 patients with an incidence rate of 8.1%, 16.3%, 36.7% and 38.7%, in ondansetron, dexamethasone and metoclopramid groups, respectively. The highest incidence of the initial nausea symptom occurred at the 1-6 hour interval in all groups (P = 0.034). Only ondansetron (P = 0.005) and dexamethasone (P = 0.019) were effective in preventing nausea at the 0-1 hour interval. The severity of nausea in patients who received dexamethasone was less. <strong>Conclusions:</strong> Ondansetron was more effective than dexamethasone and metoclopramide in preventing vomiting after laparoscopic cholecystectomy at intervals of 0-1 and 1-6 hours. Ondansetron delayed the interval of the first onset of nausea and vomiting.