ABSTRACT
To evaluate and compare the antiemetic efficiency of ondansetron with metoclopramide when administered prophylactically for the prevention of post operative nausea and vomiting after laparoscopic cholecystectomy. Prospective, Randomised, Comparative study. The study was conducted at the department of Anaesthesia Fauji Foundation Hospital, Rawalpindi from Sep 2010 to may 2011. Total 90 ASA grade-I and ASA grade-II patients, sex female, and age 35 - 70 years undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomly divided into three groups, 30 in each group. Group-I received 4 mg intravenous ondansetron, group-II received 10 mg, Intravenous nietoclopramide and group-III received intravenous 0.9% normal saline 2 minutes prior to induction of anaesthesia. They received standard General Anaesthesia for surgery. Post operative analgesia was provided with intravenous ketorelac 30 mg. There was no difference among the groups in patient charactertics and risk factors for PONV. Patients were observed for 24 hours after operation for occurrence of nausea and vomiting and requirement of rescue antiemetic. Efficiency of the drug was evaluated as [a] complete response- no nausea and no vomiting. [b] Mild response Nausea with no vomiting [c] Moderate response - 1-2 vomiting episodes I moderate nausea [d] Severe response - > 3 vomiting episodes Isevere nausea. During 1St 24 hours after operation incidence of nausea and vomiting was 77% in patients in placebo group, was 33% in patients in the ondansetron group and 53% in patients in the metoclopramide group. The incidence of PONV was significantly lower in patients who received ondansetron [P < 0.05] as compared to metoclopramide or placebo. Complete response with no nausea and vomiting was higher in patients who received ondansetron [66%] than in patients who received metoclopramide [46%] or placebo [23%]. The incidence of nausea with vomiting [moderate to severe response] was significantly lower with ondansetron [20%] as compared to metoclopramide [34%] and placebo [60%]. There was no need for another rescue antiemetic in [80%] patients, with ondansetron [67%] with metoclopramide, [40%] with placebo. Single intravenous dose of 4 mg ondansetron when administered prophylactically is more effective than 10 mg intravenous metoclopramide in the prevention of PONV after laparoscopic cholecystectomy. Single 4 mg IV dose of ondansetron reduces the incidence and severity of PONV and also requirement of rescue antiemetic in the Post operative period