Department of Anesthesiology, Duke University Medical Center, Durham,
North Carolina 27710, USA. gan00001@mc.duke.edu
Title
Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting.
Source
Anesthesiology. 85(5):1036-42, 1996 Nov.
Abstract
BACKGROUND: Breast surgery is associated with a high incidence of
postoperative nausea and vomiting. Propofol and prophylactic administration
of ondansetron are associated with a lower incidence of postoperative nausea
and vomiting. To date no comparison of these two drugs has been reported. A
randomized study was done to compare the efficacy of ondansetron and
intraoperative propofol given in various regimens. METHODS: Study
participants included 89 women classified as American Society of
Anesthesiologists physical status 1 or 2 who were scheduled for major breast
surgery. Patients were randomly assigned to one of four groups. Group O
received 4 mg ondansetron in 10 ml 0.9% saline and groups PI, PIP, and PP
received 10 ml 0.9% saline before anesthesia induction. Group O received
thiopental, isoflurane, nitrous oxide-oxygen, and fentanyl for anesthesia.
Group PI received propofol, isoflurane, nitrous oxide-oxygen, and fentanyl.
Group PIP received propofol, isoflurane, nitrous oxide-oxygen, and fentanyl.
Thirty minutes before expected skin closure, isoflurane was discontinued and
50 to 150 micrograms.kg-1.min-1 propofol was given intravenously to maintain
anesthesia. Group PP received propofol for induction and maintenance of
anesthesia, nitrous oxide-oxygen, and fentanyl. Postoperative pain relief
was provided with morphine administered by a patient-controlled analgesia
pump. The incidence of nausea and vomiting, requests for rescue antiemetic
and sedation, pain scores, and hemodynamic data were recorded for 24 h.
RESULTS: Within 6 h of surgery, groups O and PP had a lower incidence of
nausea compared with groups PI and PIP (P < 0.05). Fewer patients in
group PP (19%) vomited during the 24-h period compared with groups O (48%),
PI (64%), and PIP (52%) (P < 0.05). The incidence of antiemetic use was
also less in group PP (P < 0.05). Patients in group PP had lower sedation
scores at 30 min and at 1 h (P < 0.05). There were no differences among
the groups in pain scores, blood pressure, heart rate, respiratory rate, and
incidence of pruritus. CONCLUSIONS: Propofol administered to induce
and maintain anesthesia is more effective than ondansetron (with thiopental-isoflurane
anesthesia) in preventing postoperative vomiting and is associated with
fewer requests for rescue antiemetic and sedation in the early phase of
recovery. It is equally effective in preventing postoperative nausea as
ondansetron in the first 6 h after operation. Propofol used only as an
induction agent or for induction and at the end of surgery were not as
protective against postoperative nausea and vomiting.