Metoclopramide or ondansetron at the end of laparoscopic cholecystectomy: a comparative study on the incidence of postoperative nausea and vomiting

D. Mureşan¹, D. Grecea¹, N. Ionescu²

¹ Spitalul Clinic Judeţean de Urgenţă Cluj
² Spitalul Clinic Judeţean Oradea

Abstract

The effectiveness of metoclopramide for post­operative emesis is controversial and dependent on dosis and timing of administration.
The most important disadvantage of laparoscopic cholecystectomy, which is the elective treatment for gallstones, is represented by high incidence of postoperative nausea and vomiting.

The aim of our study was to compare the antiemetic effect of metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies.

Methods: In a prospective randomised double-blind study 107 ASA I-II patients submitted to laparoscopic cholecystectomy were randomly divided into two groups: the metoclopramide group (n = 51 patients) and ondansetron group (n = 56 patients), depending upon the i.v. antiemetic drug used at the end of surgical intervention: 20 mg of metoclopramide, res­pectively 8 mg of ondansetron. During the first 24 postoperative hours the following parametres were evaluated: the incidence of nausea and vomiting, the additional consumption of antiemetic drugs, the quality of analgesia and the inci­dence of adverse effects.

Results: The incidence of nausea in the first 24 postoperative hours was similar in the two groups stu­died. The incidence of postoperative vomiting was higher in the patients of metoclopramide group (37%) versus the patients of ondansetron group (21%), but statistically not significant (p = 0.07). The number of patients who needed rescue antiemetic drugs during the first 12 postoperative hours was higher (but statistically nonsignificant) in the patients from the ondansetron group, and higher (but statistically nonsignificant) during 12 to 24 h postoperatively in the patients from the metoclopramide group. The quality of postoperative analgesia was significantly better at 6 hours postoperatively in the patients from the metoclo­pramide group (p < 0.05), but there were no differences in consumption of analgesics. The incidence of adverse effects attributed to antiemetic drugs was similar in the two groups.

Conclusion: The prophylactic i.v. administration of 20 mg of metoclopramide at the end of laparoscopic cholecystectomy had similar antiemetic effect with the i.v. administration of 8 mg of ondansetron, with no differences in the incidence of adverse effects.

Keywords: nausea, vomiting, laparoscopic cholecys­tectomy, ondansetron, metoclopramide

Metoclopramid sau ondansetron la sfârşitul colecistectomiei laparoscopice: studiu comparativ asupra incidenţei greţurilor şi vărsăturilor postoperatorii