ABSTRACT
In a randomized, double-blind study, the prophylactic antiemetic cost-efficacy of epphedrine, metoclopramide and ondansetron in 100 patients undergoing general anaesthesia for day-case gynacological laparoscopic surgery were compared. A standard general anaesthetic technique was used for all patients. Ten min. before the end of surgery, patients were classified into 4 groups each [n=25]. Placebo, ephedrine, metoclopramide and ondansetron groups and they receive 3 ml saline i.m, 0.5 mg/kg ephedrine i.m, metoclopramide 10 mg i.v and ondansetron 4 mg i.v respectively. During the first two hours after anaesthesia [early vomiting], the incidence of postoperative nausea and vomiting [PONV] was 68%, 28%, 32% and 20% after administration of saline, ephedrine, metoclopramide and ondansetron respectively [P<0.05]. There was a significant difference between placebo and other groups. However there was no difference between ephedrine, metoclopramide and ondansetron groups in the incidence of PONV. During the time between 2 hours and 24 hours postoperatively [delayed vomiting], the incidence of PONV was 80%, 72%, 44% and 24% in saline ephedrine, metoclopramide and ondansetron group respectively. There was a significant difference between ondansetron group and other groups [P<0.05]. No difference in the incidence of once administration of rescue drug but there is a great difference in the incidence of twice or more administration of rescue drug between ondansetron and other groups [P<0.05]. No difference in the incidence of adverse events was observed between groups. There was a great difference in price between ondansetron and other drugs. This study was concluded that the prophylactic administration of I.V ondansetron was not superior to ephedrine and metoclopramide in preventing early PONV but only in preventing delayed PONV and its cost did not justify as for use in our country as a routine prophylactic antiemetic drug against PONV