ONDANSETRON VERSUS METOCLOPRAMIDE IN THE TREATMENT OF POSTOPERATIVE NAUSEA AND VOMITING

In this prospective, randomized, double-blind study, we compared the e fficacy and safety of ondansetron and metoclopramide in the treatment of postoperative nausea and vomiting (PONV). One hundred seventy-five patients with PONV during recovery from anesthesia for gynecological l aparoscopy were treated intravenously with either ondansetron 4 mg (58 patients), metoclopramide 10 mg (57 patients), or placebo (60 patient s). Early antiemetic efficacy (abolition of vomiting within 10 min and of nausea within 30 min from the administration of the study drugs wi th no further vomiting or nausea episodes during the first hour) was o btained in 54 of 58 patients (93.1%) in the ondansetron group, in 38 o f 57 patients (66.7%) in the metoclopramide group, and in 21 of 60 pat ients (35%) in the placebo group (P < 0.001). This difference was stil l significant when controlling for age, body weight, history of motion sickness, previous PONV episodes, duration of anesthesia, and intraop erative fentanyl consumption using a logistic model. Early antiemetic efficacy was inversely related to the amount of fentanyl administered during anesthesia, regardless of treatment. According to the Kaplan-Me ier method, the probability of remaining PONV-free for 48 h after a su ccessful treatment was 0.59 (95% confidence interval 0.45-0.71) in the ondansetron group, 0.45 (0.29-0.60) in the metoclopramide group, and 0.33 (0.15-0.53) in the placebo group (P = 0.003). In conclusion, onda nsetron 4 mg is more effective than metoclopramide 10 mg and placebo i n the treatment of established PONV.