Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial

Abstract

Objectives To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions. Design Four-armed, parallel group, double blind, randomised controlled clinical trial. Setting Four clinics of a university hospital and four district hospitals in Germany. Participants 3140 patients who received balanced or regional anaesthesia during surgery. Main outcome measures Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions. Results Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting ( > 12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. Conclusion The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions. Trial registration Current Controlled Trials ISRCTN31625370.

Comparison of Ondansetron versus Acupressure on Pressure Point Neiguan (P-6) to Prevent Post Operative Nausea and Vomiting after Middle Ear Surgery: A Randomized Double Blind Study

“…Several hypotheses have been described this as ambiguity, but it might be due to its influence on restoration of the body's energy balance 7 . In Chinese medicine, P6 point is called as the peak of body energy 8 and therefore, when Acupressure is competently applied, the body's energy balance will be restored. In other studies, the effect of Acupressure at P6 was confirmed in various medical interventions 9,10 .…”

Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides

“…La metoclopramida es un antiemético procinético muy utilizado en nuestro entorno, pese a cuestionarse su eficacia a la dosis habitual de 10 mg iv (31)(32)(33). A dosis más altas (20-50 mg) es efectiva (NNT 17 y 11 para dosis de 25 y 50 mg respectivamente) (33), pero aumenta la tasa de efectos adversos (33,34).…”

“…Actualmente en diferentes centros europeos y de EE.UU. sigue teniendo un lugar en los protocolos de prevención y tratamiento de las NVPO (33,35), mientras otros autores excluyen esta posibilidad (36). La clorpromacina es efectiva pero igualmente presenta inconvenientes por sus efectos secundarios 1 .…”

“…Así pues, el tratamiento de las NVPO es imperativo en cualquier caso, independientemente del régimen profiláctico utilizado. En general, los fármacos utilizables como tratamiento son los mismos que en profilaxis, y la combinación de varios es, también en este caso, más efectiva que la administración de sólo uno de ellos (33,52). El tratamiento difiere según la situación de partida, es decir, dependiendo de si se ha usado o no pauta de profilaxis y si ha sido así, del fármaco usado en la profilaxis (Tabla IV).…”

Treatment of acute abdominal pain in the emergency room: A systematic review of the literature

“…Treatment for these side effects depends on the receptors involved, and is mainly based on treatment of post-operative opioid-related nausea and vomiting (Tramèr, 2001;Apfel et al, 2004;Büttner et al, 2004;Harris, 2008). Ondansetron and metoclopramide, as seen in Table 1, are effective agents to treat opioid-induced nausea and vomiting (Tramèr, 2001;Apfel et al, 2004;Büttner et al, 2004;Wallenborn et al, 2006). Alternative agents to treat narcotic-associated nausea and vomiting in this setting include droperidol, haloperidol and dexamethasone.…”