COMPARISON OF TROPISETRON, DROPERIDOL, AND SALINE IN THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING AFTER GYNECOLOGIC SURGERY

This study was performed to compare the efficacy of tropisetron, drope ridol, and saline in the prevention of postoperative nausea and vomiti ng (PONV) and to compare the possible adverse effects of these drugs i n gynecologic incontinence surgery. Using a randomized, double-blind s tudy design, we studied 150 women undergoing gynecologic incontinence surgery with standardized general anesthesia. At the end of surgery, t he patients received either tropisetron 5 mg, droperidol 1.25 mg, or 0 .9% saline intravenously (IV). As a rescue antiemetic, the patients re ceived metoclopramide 10 mg IV. The episodes of nausea, retching, and vomiting; the need for rescue treatment; and the type and severity of adverse events were recorded at four occasions during the 48-h observa tion period. Pain, anxiety, drowsiness, and general satisfaction were also evaluated on a linear numerical scale of 0-10. Complete response (no PONV within the 48-h observation period) occurred similarly in the study groups (tropisetron 25%, droperidol 22%, and placebo 18%). Trop isetron and droperidol had no effect on the incidence of nausea and re tching. However, the incidence of vomiting was significantly less in t he tropisetron group than in the placebo group (tropisetron 19%, drope ridol 45%, and placebo 57%). The number of emetic episodes (retching a nd/or vomiting) per patient within 48 h was significantly decreased un der tropisetron when compared with placebo (tropisetron 2.5 +/- 3.4, d royeridol 4.2 +/- 6.1, placebo 5.9 +/- 7.1). With regard to adverse ev ents, the patients in the droperidol group had significantly more anxi ety than the placebo group (2-6 h postoperatively), more drowsiness th an the tropisetron and placebo groups (0-2 h postoperatively), and mor e dissatisfaction than the tropisetron (0-6 h postoperatively) and pla cebo groups (2-6 h postoperatively). We conclude that tropisetron give n 5 mg IV during anesthesia in gynecologic incontinence surgery effect ively prevents vomiting but not nausea and retching, while 1.25 mg IV droperidol fails to prevent any of these emetic symptoms and results i n adverse events.