COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE FOR THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING AFTER MAJOR GYNECOLOGICAL SURGERY

The efficacy of ondansetron 4 mg was compared with metoclopramide 10 m g for the prevention of postoperative nausea and vomiting in patients after major gynaecological abdominal surgery. Anaesthesia was standard ized using thiopentone, atracurium and methadone for induction followe d by isoflurane in nitrous oxide-oxygen mixture. Fifty patients were r andomized in a double-blind fashion to either receive intravenous (i.v .) ondansetron 4 mg or metoclopramide 10 mg during closure of the pelv ic peritoneum. The incidence and frequency of vomiting, and the incide nce of severe nausea was recorded for 24 h after surgery. One patient was excluded because of respiratory depression. In the first 4 h after surgery, five patients (20%) in the ondansetron group (n = 25) and ei ght patients (33%) in the metoclopramide group (n = 24) vomited, where as at 4-12 h, this increased to 11 patients (44%) and nine patients (3 7.5%) respectively. The incidence was 52 and 37.5% respectively in the subsequent 12-24 h. The highest incidence of nausea was in the first 4 h after surgery, being 56 and 37.5% in the ondansetron and the metoc lopramide groups respectively. This decreased to less than 25% in both groups in the 12-24 h period. Ondansetron 4 mg and metoclopramide 10 mg had similar but short lasting efficacy for the prevention of vomiti ng in patients who received continued opioid analgesia after major gyn aecological surgery.