A RANDOMIZED DOUBLE-BLINDED COMPARISON OF METOCLOPRAMIDE, ONDANSETRONAND CYCLIZINE IN DAY-CASE LAPAROSCOPY

This study determined the overall incidence of postoperative nausea an d vomiting (PONV) in 38 patients undergoing laparoscopic gynaecologica l procedures who received a standardized propofol/isoflurane anaesthet ic bur no preoperative antiemetic. A further 166 patients similarly an aesthetized were then randomly allocated to receive either metoclopram ide 10 mg, ondansetron 4 mg, or cyclizine 50 mg as an intravenous anti emetic immediately preinduction. Overall incidence of PONV was determi ned for all groups and the relative efficacy of the three antiemetic a gents assessed. Fifty per cent of patients in the initial group (no an tiemetic) reported significant nausea and/or vomiting up to 24 hours p ostoperatively. The incidence of PONV in the metoclopramide group was 24%, in the ondannsetron group 20%, and in the cyclizine group 51%. Th ere was no detectable difference in relative efficacy between ondanset ron 4 mg and metoclopramide 10 mg. The incidence of PONV in the group who received cyclizine was similar to that found in the pilot group wh o received no PONV prophylaxis. Both metoclopramide and ondansetron ma y potentially decrease the incidence of PONV following gynaecologic la paroscopy by up to 50% when administered intravenously prior to a prop ofol/isoflurane anaesthetic.