Prevention of postoperative nausea and vomiting after laparoscopic gynaecological surgery. Combined antiemetic treatment with tropisetron and metoclopramide vs. metoclopramide alone

Background and objective Female patients undergoing gynaecological procedur es, especially laparoscopically, are at high risk of postoperative nausea a nd vomiting. No available antiemetic is entirely effective. This double-bli nded randomized trial examines the efficacy and safety of tropisetron and m etoclopramide in combination and compares the results with metoclopramide a lone in laparoscopic gynaecological surgery. Methods One hundred and twenty female patients scheduled for minor gynaecol ogical laparoscopy, aged 27-43 years, were randomly allocated to receive pr etreatment with metoclopramide 10 mg intravenously (n = 57) or tropisetron 5 mg with metoclopramide 5 mg (n = 63). Results Fewer patients in the combined treatment group experienced postoper ative nausea and vomiting (14% vs. 37%, P = 0.008) or needed rescue antieme tic treatment (3% vs. 16%, P = 0.038). No significant adverse events were o bserved. Conclusions The combination of the antiemetics was superior, which is proba bly explained by the fact that the two drugs have different sites of action , thus preventing emesis by blocking different pathways.