A Comparison of the Antiemetic Effect of Ondansetron and Metoclopramide on Nausea and Vomiting Associated with Epidural Buprenorphine / 대한마취과학회지

BACKGROUND: Epidural buprenorphine provides good pain relief after Cesarean section, but is often associated with nausea and vomiting. Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, is known to prevent and treat emesis after chemotherapy in cancer patients and after general anesthesia. The purpose of this study was to compare the prophylactic antiemetic effect of ondansetron and metoclopramide on nausea and vomiting after epidural buprenorphine. METHODS: Sixty women undergoing Cesarean section were studied. The patients were given subarachnoid injections of 0.5% tetracaine 9 mg and were inserted with epidural catheters for postoperative pain control. Prior to closure of the peritoneum, we injected a mixture of buprenorphine and bupivacaine through the epidural catheters and gave intravenous boluses of saline 6 ml, metoclopramide 10 mg and ondansetron 4 mg randomly. The incidence of nausea and vomiting and the degree of satisfaction were evaluated until 24 hr after the injection of epidural buprenorphine. RESULTS: The number of patients who became nauseated or vomited did not differ significantly between the ondansetron group and the metoclopramide group. Also, subjective ratings of satisfaction and incidence of other side effects did not differ significantly between the groups. CONCLUSIONS: Ondansetron, administered intravenously, prevented postoperative nausea and vomiting associated with epidural buprenorphine equally as well as metoclopramide.

Effects of Concentration of Preoperatively Administered Epidural Bupivacaine on Postoperative Pain Control / 대한마취과학회지

BACKGROUNDS: Epidural anesthesia before surgical stimulus may reduce or prevent subsequent pain by preemptive analgesia. We studied the effect of varied concentration of a local anesthetic agent administered through epidural catheter before operation on preemptive analgesia after an abdominal hysterectomy. METHODS: Fourty-five patients scheduled for abdominal hysterectomy were blindly randomized to receive 10 ml of 0.5% bupivacaine (group I), 0.25% bupivacaine (group II) or saline (group III) respectively before induction of anesthesia. For postoperative pain control all patients received the same analgesic regimen which was 10 ml of 0.125% bupivacaine and buprenorphine 0.15 mg after resection of the uterus. Then the epidural catheter was connected with infusion pump containing 100 ml of 0.125% bupivacaine and buprenorphine 0.45 mg. Its infusion rate was 2 ml/hour. Pain was assessed using the Visual Analogue Scale (0 = no pain to 10 = intolerable pain) on rest, motion, cough and verbal rating scale at 1, 3, 6, 24 and 48 hour after operation. Side effects were recorded at the same time intervals. RESULTS: Using the ANOVA on ranksum test, pain scores 1 hour after operation differed between groups I and III (P<0.05). In VAS in motion, the pain scores 24 hours after operation differed between groups I and III (P<0.05). In VRS, the pain scores 3 hours after operation differed between groups II and III (P<0.05), and those 24 hours after operation differed between groups I and III (P< 0.05). The incidence of motor weakness using Chi-square test in group I differed from groups II, III (P< 0.05). CONCLUSIONS: Among the 45 patients who had a postoperative pain control after abdominal hysterectomy with initial bolus injection and then continuous infusion of epidural bupivacaine and buprenorphine, postoperative pain scores of patients who had preoperative epidural injection of 10 ml of 0.5% bupivacaine (n = 15) were lower than those of saline injected patients (n = 15), but those of patients with a preoperative epidural injection of 10 ml of 0.25% bupivacaine (n = 15) were not lower than those of saline injected patients.