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
Kaara, Bernard Kimori
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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.