COMPARISON OF ONDANSETRON, METOCLOPRAMIDE AND PLACEBO AS PREMEDICANTSTO REDUCE NAUSEA AND VOMITING AFTER MAJOR SURGERY

In a randomised, double-blind study, we have compared the incidence of postoperative nausea and vomiting in 124 patients undergoing major lo wer limb orthopaedic surgery following oral premedication with temazap am and ondansetron 8 mg, metoclopramide 10 mg or placebo. They receive d a standardised epidural and general anaesthetic. An epidural mixture containing bupivacaine 0.1% and fentanyl 10 mg.ml(-1) was infused pos toperatively. The occurrence of nausea and vomiting was assessed every 4 h for 24 h. The incidence of vomiting significantly decreased from 55% and 43% in the placebo and metoclopramide groups, respectively, to 26% in the ondansetron group (p = 0.03). The incidence of nausea and vomiting in patients who had previously suffered was also significantl y reduced from 67% and 68% in the placebo and metoclopramide groups, r espectively, to 29% in the ondansetron group (p = 0.035). We conclude that oral premedication with ondansetron 8 mg was superior to metoclop ramide 10 mg and placebo in preventing postoperative nausea and vomiti ng following major orthopaedic surgery in patients given epidural opio id analgesia.