Comparison Of 5-hydroxytryptamine (serotonin) Receptor Type 3 (5HT3) Antagonist Ondansetron With Metoclopramide In The Control Of Postoperative Nausea And Vomiting In-patients Undergoing Gynaecological Operations In Kenyatta National Hospital
Abstract
Most studies comparing the use ondansetron and metoclopramide in control of
postperative nausea and vomiting (PONV) demonstrate a greater degree of control upto
75% with ondanstron (29,30,31). The present study determined and compared the
control of PONV) of ondanstron and metoclopramide and their side effect profiles in-patients
undergoing gynaecological surgery.
Ondansetron and metoclopramide in doses of 4mg and 1Omg respectively were used on
60 patients of the American Society of Anaesthesiologists class 1 and II undergoing
elective gynaecological surgery. The control of PONV was determined by determining
the number of vomiting episodes that occurred in 24 hrs after the patient had received
either of the drugs ondansetron or metoclopramide side effects profiles was determined
by noting the presence of sedation which was graded as absent, mild to moderate or
marked; presence of extrapyramidal reactions and presence of diarrhea. Informed signed
consent was obtained from each patient. Premedication was with 1 mg/Kg pethidine
hydrochloride and Atropine 0.6 mg all given intramuscularly. Anaesthesia induction was
with sodium thipentone at a dose of 5mglKg and suxamethonium at a dose of2 mg/Kg,
maintenance and reversal drugs were standardized. Patients were monitored using an
ECG monitor life scope 6 and Blood pressure was monitored with Blood pressure
.machinemode DS 91.
The present study found that ondanstron gIves a superior control of PONV when
compared to metoc1opramide. Ondansetron gave good control of PONY in 76% patients
studied. The remaining 24% had 1 or 2 episodes of vomiting in the 24 hrs of study.
Metoclopramide gave good control in 64% of the patient studied, of the remaining 36% 6
had 1- 3 episodesof vomiting, 3 had 3 - 4 episodes of vomiting and 2 had 5 episodes of
vomiting.
There was significant difference between the two drugs ( P value 0.04 ). This was less
than 0.05 meaning that ondansetron had better control of PONV than metoclopramide.
Ondansetron was found to be more superior in control of PONV than Metodopramide.
Both drugs had very low profiles of side effect. None caused extrapyramidal effects and
only two patients developed diarrhoea. The study recommends that Ondansetron to be
used both in prophylaxis and treatment of PONY. More research is recommended
especially in combined therapy so that we can come up with cheap and better solution for
control of postoperative nausea and vomiting.
Citation
Master Of Medicine In Anaesthesia, The University Of Nairobi, 2002Publisher
University of Nairobi. Faculty of Medicine, College of Health Sciences