The search for cost-effective prevention of postoperative nausea and vomiting in the child undergoing reconstructive burn surgery: Ondansetron versusdimenhydrinate

Postoperative nausea and vomiting (PONV) is a common and unpleasant problem for children with burns who are undergoing reconstructive burn surgery. On dansetron and dimenhydrinate have been found to be effective for the preven tion of PONV in other patient populations, but they have not been directly compared in the pediatric population. A prospective, randomized, double-bli nd, placebo-controlled comparison of ondansetron and dimenhydrinate was per formed. One hundred patients with a mean age of 11.8 years who were undergo ing reconstructive burn surgery with general anesthesia were randomly assig ned to receive either a placebo, 0.1 mg/kg of ondansetron, or 0.5 mg/kg of dimenhydrinate. The 3 groups were well matched for all demographic and proc edural variables. The study drugs were given twice, first at the end of sur gery and again 4 hours later, to ensure adequate blood levels during the 8- hour study period. Postoperatively, on the basis of the presence and amount of PONV experienced, all patients were assigned a PONV score by a blinded investigator. Statistically significant reductions in the incidence of PONV in the patients who received ondansetron or dimenhydrinate were found, as compared with the results of patients who received placebo. Postoperative v omiting was reduced from 61% in the placebo group to 29% and 40% in the ond ansetron and dimenhydrinate groups, respectively, and PONV was similarly re duced from 69% to 47% and 40%, respectively. The differences between ondans etron and dimenhydrinate were not significant. The average cost to our phar macy for the prescribed dose of ondansetron was $19.34; the cost for dimenh ydrinate was $0.90. In this patient population, dimenhydrinate was as effec tive as ondansetron for the prevention of PONV and postoperative vomiting, and it was much less expensive.