Volume : 3, Issue : 1, JAN 2017

COMPARISON OF PROPHYLACTIC EFFECTS OF INTRAVENOUS METOCLOPRAMIDE AND ONDANSETRON ON POSTOPERATIVE NAUSEA AND VOMITING (PONV) AFTER MAXILLOFACIAL SURGERY.

SAEED NEZAFATI, DR.ABBASALI DEHGHANI, DR.DAWOOD AGHAMOHAMMADI, DR.HOSSEIN DABBAGH

Abstract

Background and aims Postoperative nausea and vomiting (PONV) remains a significant problem in patients undergoing maxillofacial surgery. PONV is dangerous because it can result in aspiration and patient suffocation especially in patients undergoing intermaxillary fixation (IMF) after the surgery and the mouth is closed. The aim of the present study was to compare the prophylactic effects of intravenous ondansetron and metoclopramide in controlling the PONV in maxillofacial surgery. Materials and methods A total of 175 patients with the age range of 18?50 years were randomly allocated into 5 groups. Groups one and two received ondansetron 0.15 mg/kg intravenously in a double-blind manner 30 minutes before surgery or 30 minutes before recovery. Groups three and four received metoclopramide 0.5 mg/kg intravenously in a double-blind manner 30 minutes before surgery or 30 minutes before recovery. In Group 5 (control), metoclopramide was administered postoperatively according to the patient’s need. An independent surgeon recorded the postoperative results. Results The incidence of nausea and vomiting was highest in the control group (C=33.01%) and lowest when ondansetron was given 30 minutes before the end of anaesthesia (Oa=4.71%) (P=0.001). Regarding the absence of nausea and vomiting 24 hours after surgery, the peak incidence for PONV was recorded 30 minutes after full consciousness for all the groups. The incidence of PONV was significantly lower when ondansetron was given before recovery (2.38% for the group one in comparison to 7.61% of the group 2) (p=0.045). Conclusion It can be concluded that ondansetron is significantly more efficacious than metochlopramide in preventing PONV. The best administration time is 30 minutes before recovery.

Article : Download PDF

Cite This Article

Article No : 11

Number of Downloads : 975

References

1. McCracken G, Houston P, Lefebvre G. Guideline for the management of postoperative nausea and vomiting. Journal of obstetrics and gynaecology Canada: JOGC= Journal d'obstetrique et gynecologie du Canada: JOGC 2008;30:600-7, 8-16. 2. Rüsch D, Eberhart L, Biedler A, Dethling J, Apfel CC. Prospective application of a simplified risk score to prevent postoperative nausea and vomiting. Canadian Journal of Anesthesia 2005;52:478-84. 3. Tramèr MR. Strategies for postoperative nausea and vomiting. Best Practice & Research Clinical Anaesthesiology 2004;18:693-701. 4. Biedler A, Wermelt J, Kunitz O, Müller A, Wilhelm W, Dethling J, et al. A risk adapted approach reduces the overall institutional incidence of postoperative nausea and vomiting. Canadian Journal of Anesthesia 2004;51:13-9. 5. Carlisle J, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. The Cochrane Library 2006. 6. Henzi I, Walder B, Tramer M. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. British Journal of Anaesthesia 1999;83:761-71. 7. Talesh KT, Motamedi MHK, Kahnamouii S. Comparison of ondansetron and metoclopramide antiemetic prophylaxis in maxillofacial surgery patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2011;111:275-7. 8. Kim EJ, Ko JS, Kim CS, Lee SM, Choi DH. Combination of antiemetics for the prevention of postoperative nausea and vomiting in high-risk patients. Journal of Korean medical science 2007;22:878-82. 9. Diemunsch P, Conseiller C, Clyti N, Mamet J. Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting. The French Ondansetron Study Group. British journal of anaesthesia 1997;79:322-6. 10. Krobbuaban B, Pitakpol S, Diregpoke S. Ondansetron vs. metoclopramide for the prevention of nausea and vomiting after gynecologic surgery. Medical journal of the Medical Association of Thailand 2008;91:669. 11. Sandhu T, Tanvatcharaphan P, Cheunjongkolkul V. Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy: a prospective double-blind randomized study. Asian Journal of Surgery 2008;31:50-4.