Study of the influence of type of ENT surgical procedure on the frequency of postoperative nausea and vomiting and the role of prophylactic antiemetics

ABSTRACT

This study was designed to determine the frequency of Postoperative Nausea and Vomiting [PONV] after variant ENT surgeries and to evaluate the efficacy of prophylactic tropisetron for prevention. The study comprised 100 patients [50 males and 50 females]. Their ages ranged between 10-20 years and were randomly allocated into two equal groups Placebo group received preoperative normal saline and Tropisetron group received tropisetron [5mg]. A dose of IV metoclopramide was given postoperatively as rescue antiemetic. Forty patients underwent tonsillectomy, 20 patients had nasal surgery and 40 patients had ear surgery. PONV was reported in 51 patients 32 in the placebo group and 19 in the tropisetron group. The frequency of PONV was 67.5% after ear surgery, 47.5% after tonsillectomy and 25% after nasal surgery. Patients who were operated for mastoidectorny had a higher frequency [75%] than those who underwent myringotomy [60%]. Moreover, older patients who underwent tonsillectomy had a higher frequency [55%] than younger ones [40%]. There was a positive non-significant correlation between age and frequency of PONV in the placebo group, despite the positive significant correlation in those who underwent tonsillectomy, [r=0.498, p=0.026]. As regards sex predilection, 33 females and 28 males had PONV. There was a significant [P<0.0l] reduction in frequency of PONV in patients who received tropisetron [3 8%] compared to placebo [64%]. Nausea was detected in 12 patients, retching in 8 patients and vomiting in 12 patients in the placebo group, while in the tropisetron group nausea was detected in 9 patients, retching in 6 patients and vomiting in only 4 patients, with a significant decrease in severity in tropisetron group. Also, there was a significant increase in severity of PONV in favor of ear surgery. Rescue antiemetic was required by 19 [3 8%] patients in placebo and 8 patients [16%] in tropisetron group. We can conclude that surgical manipulations at ear and tonsil regions are associated with more frequency of PONV that could be reduced by the prophylactic use of tropisetron