The Effect of Dexamethasone Combined with Ondansetron on Antiemesis and Analgesia during Postoperative Patient Controlled Analgesia / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of postoperative nausea and vomiting for the patient using a patient controlled analgesia (PCA). METHODS: Of sixty women having general anesthesia for total abdominal hysterectomy (TAH), thirty received intravenous ondansetron 4 mg plus 150 microgram/kg of dexamethasone (Group 1) and thirty received intravenous ondansetron 4 mg plus saline 2 ml (Group 2) after awakening. Butorphanol 10 mg, ketorolac 180 mg and ondansetron 4 mg were connected to PCA pump for postoperative pain control. The severity of nausea, vomiting and pain were assessed at 0, 1, 2, 6, 12, 24, 36 and 48 hr after awakening. RESULTS: Nausea and vomiting occurred in 5 patients in Group 1 and in 4 patients in Group 2. There were no significant differences between groups in nausea, vomiting and pain scores. CONCLUSIONS: The combination of ondansetron and dexamethasone is not more effective than ondansetron alone in prevention of postoperative nausea, vomiting and pain for women having PCA following TAH.

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.

A Comparison of the Effects of Ondansetron and Granisetron on the Prevention of Postoperative Nausea and Vomiting after Gynecologic Surgery / 대한마취과학회지

BACKGROUND: The purpose of this study was to compare the effects of ondansetron and granisetron on the prevention of postoperative nausea and vomiting (PONV) in gynecologic patients. METHODS: In a randomized placebo-controlled study, 200 gynecologic patients were divided into 5 groups. Each patient received one of 5 medications: placebo (saline 3 ml), ondansetron 4 mg (O4), ondansetron 8 mg (O8), granisetron 1.5 mg (G1.5) and granisetron 3 mg (G3). They were administered intravenously immediately before the induction of anesthesia. A standardized inhalation anesthesia and a postoperative intravenous patient-controlled analgesia were applied. Twenty four hours after anesthesia, the incidence and severity of PONV and other adverse effects were assessed. RESULTS: The incidence of PONV was 88%, 83%, 75%, 70% and 60% in the placebo, O4, O8, G1.5 and G3 groups, respectively, which showed significantly lower value in the G3 group than in the placebo and O4 groups (P< 0.05). The severity of PONV was also significantly lower in the G3 group than in the placebo group (P < 0.05). CONCLUSIONS: In this study, granisetron 3 mg showed a better prophylactic effect in the mitigation of PONV in gynecologic patients then a placebo or ondansetron 4 mg.

Effects of Transdermal Scopolamine on Postoperative Nausea and Vomiting during Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) provides excellent pain relief in the management of postoperative pain, but is associated with unpleasant side effects such as nausea and vomiting. The transdermal scopolamine patch (TSP) has been shown to have effective antiemetic actions. We evaluated the effectiveness of TSP in patients receiving morphine and fentanyl via intravenous PCA. METHODS: Sixty patients were scheduled for an elective intra-abdominal gynecologic surgery under general anesthesia, and had elected to receive intravenous PCA postoperatively. Soon after their arrival in the operating room, the patients were randomised to receive either a placebo patch (group P) or TSP (group S) on the right postauricular area. Nausea, vomiting and sedation were scored at the postoperative care unit (PACU) and at 12, 24, 48, and 72 h postoperatively. Patients were treated with metoclopramide as deemed necessary by the primary care nurse. RESULTS: No differences were found between the groups in scores and incidence of nausea and vomiting at the PACU and at 12, 24, 48, and 72 h postoperatively. The patients who received metoclopramide were significantly fewer in group S than in group P (6.7% vs 43.3%, P < 0.05). The sedation score was significantly lower in group S than in group P (1.3 0.5 vs 1.8 0.9, P < 0.05) at 12h postoperatively. CONCLUSIONS: TSP did not reduce the incidence and score of nausea and vomiting in postoperative patients during intravenous PCA. However, patients who received TSP required less antiemetic medication. TSP appears to be effective for supplemental antiemetic medication.

Effects of Transdermal Scopolamine on Postoperative Nausea and Vomiting during Patient-controlled Analgesia / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) provides excellent pain relief in the management of postoperative pain, but is associated with unpleasant side effects such as nausea and vomiting. The transdermal scopolamine patch (TSP) has been shown to have effective antiemetic actions. We evaluated the effectiveness of TSP in patients receiving morphine and fentanyl via intravenous PCA. METHODS: Sixty patients were scheduled for an elective intra-abdominal gynecologic surgery under general anesthesia, and had elected to receive intravenous PCA postoperatively. Soon after their arrival in the operating room, the patients were randomised to receive either a placebo patch (group P) or TSP (group S) on the right postauricular area. Nausea, vomiting and sedation were scored at the postoperative care unit (PACU) and at 12, 24, 48, and 72 h postoperatively. Patients were treated with metoclopramide as deemed necessary by the primary care nurse. RESULTS: No differences were found between the groups in scores and incidence of nausea and vomiting at the PACU and at 12, 24, 48, and 72 h postoperatively. The patients who received metoclopramide were significantly fewer in group S than in group P (6.7% vs 43.3%, P < 0.05). The sedation score was significantly lower in group S than in group P (1.3 0.5 vs 1.8 0.9, P < 0.05) at 12h postoperatively. CONCLUSIONS: TSP did not reduce the incidence and score of nausea and vomiting in postoperative patients during intravenous PCA. However, patients who received TSP required less antiemetic medication. TSP appears to be effective for supplemental antiemetic medication.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.

Nausea and Vomiting after Tympanomastoidectomy: Effect of Small Dose of Fentanyl / 대한마취과학회지

BACKGROUND: Nausea and vomiting are among the most common postoperative complaints. There is high incidence of emesis after middle ear surgery and opioids increase the prevalence of postoperative nausea and vomiting. METHODS: Sixty six adult patients undergoing routine tympanomastoidectomy under general anesthesia were divided into two groups to study the incidence and effect of intraoperative fentanyl as supplements on postoperative nausea and vomiting. Patients in group 1 received medical air instead of N2O about 15 minutes before grafting, while patients in group 2 received not only medical air instead of N2O, but also intravenous fentanyl (1~1.5 microgram/kg). RESULTS: The incidences of nausea and vomiting in the group 1 and 2 were 19.4% and 22.9%, respectively. There was no significant difference of postoperative nausea and vomiting between the group 1 and group 2 (P=0.73). CONCLUSION: The incidence of nausea and vomiting after tympanomastoidectomy in adult was not higher than comprehensive that of recent other reports and a small dose of fentanyl, given intraoperatively for supplementation, did not increase the prevalence of nausea and vomiting.