Comparison of anti-emetic effects of ondansetron, metoclopromide or a combination of both in children undergoing surgery for strabismus

This prospective, randomized and double-blinded study was designed to evalu ate the anti-emetic efficacy of a combination of ondansetron and metoclopra mide in 100 ASA physical status I and II children of either sex and 1-15 ye ars of age undergoing elective surgery for strabismus. A standardized anaes thetic technique and post-operative analgesia were used for all the childre n. Children were divided into four groups. They received saline, metoclopro mide 250 mu g kg(-1), ondansetron 150 mu g kg(-1) or a combination of metoc lopramide 150 mu g kg(-1) and ondansetron 100 mu g kg(-1) intravenously imm ediately after the insertion of an intravenous cannulae. There were no diff erences between the groups in their age, gender, weight, duration of surger y, number of muscles subjected to surgery or intravenous fluids received. I n the first 24 post-operative hours, 18 (72%) patients in the placebo group , 15 (60%) patients in the metoclopramide group, 10 (40%) patients in the o ndansetron group and 11 (44%) patients in the combination group had nausea or vomiting. The overall incidence of post-operative nausea and vomiting wa s significantly (P < 0.05) lower in the combination group and in the ondans etron group compared with the placebo group. Nine (36%) patients in both th e placebo and the metoclopramide groups and one (4%) patient in the ondanse tron group required rescue anti-emetic treatment. None of the patients in t he combination group required rescue anti-emetic and this was significantly less (P <0.01) when compared with the placebo and the metoclopramide group s. Recovery and sedation scores were comparable in all the four groups. A c ombination of metoclopramide 150 mu g kg(-1) and ondansetron 100 mu g kg(-1 ) administered prior to surgery was not found to be more effective than ond ansetron 150 mu g kg(-1) alone for the prophylaxis of nausea and vomiting f ollowing surgical repair of strabismus in paediatric patients.