R. Alexander et M. Fennelly, COMPARISON OF ONDANSETRON, METOCLOPRAMIDE AND PLACEBO AS PREMEDICANTSTO REDUCE NAUSEA AND VOMITING AFTER MAJOR SURGERY, Anaesthesia, 52(7), 1997, pp. 695-698
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.