The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

Koyuncu, Onur; Leung, Steve; You, Jing; Oksar, Menekse; Turhanoglu, Selim; Akkurt, Cagla; Dolapçıoğlu, Kenan; Şahin, Hanifi; Sessler, Daniel I.; Turan, Alparslan

doi:10.1016/j.jclinane.2017.03.049

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…Koyuncu et al . 129 found that ondansetron 8 mg decreased the analgesic effect of acetaminophen 1 g (then 1 g every 6 hours for 24 hours) during the initial postoperative period after hysterectomy. Granisetron, a more selective 5-HT 3 antagonist, has been suggested to provide more sustained antiemesis as a prophylactic 124 .…”

Section: Perioperative Antiemetic Drugs Used For the Treatment And/ormentioning

confidence: 97%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.

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Section: Perioperative Antiemetic Drugs Used For the Treatment And/ormentioning

confidence: 97%

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

et al. 2020

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“…At the end of the surgical procedure, all subjects received intravenous ondansetron 4 mg and 30 mg of intravenous ketorolac. [ 18 , 19 ]…”

Section: Methodsmentioning

confidence: 99%

Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy

2018

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Introduction:Intraoperative systemic esmolol has been shown to reduce postsurgical pain. Nonetheless, it is unknown whether the use of intraoperative systemic esmolol can improve patient-reported postsurgical quality of recovery. The main objective of the current investigation was to evaluate the effect of intraoperative esmolol on postsurgical quality of recovery. We hypothesized that patients receiving intraoperative esmolol would report better quality of postsurgical recovery than the ones receiving saline.Methods:The study was a prospective randomized double-blinded, placebo-controlled, clinical trial. Healthy female subjects undergoing outpatient hysteroscopic surgery under general anesthesia were randomized to receive intravenous esmolol administered at a rate of 0.5 mg/kg bolus followed by an infusion of 5 to 15 μg/kg/min or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included postoperative opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test.Results:Seventy subjects were randomized and 58 completed the study. There was not a clinically significant difference in the global QoR-40 scores between the esmolol and saline groups at 24 hours, median (interquartile range) of 179 (171–190) and 182 (173–189), respectively, P = .82. In addition, immediate post-surgical data in the post-anesthesia care unit did not show a benefit of using esmolol compared to saline in regard to pain scores, morphine consumption, and postoperative nausea and vomiting.Conclusions:Despite current evidence in the literature that intraoperative esmolol improves postsurgical pain, we did not detect a beneficial effect of intraoperative esmolol on patient-reported quality of recovery after ambulatory surgery. Our results confirm the concept that the use of patient-centered outcomes rather than commonly used outcomes (e.g., pain scores and opioid consumption) can change the practice of perioperative medicine.

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“…39 A randomized, double-blinded study showed that ondansetron (8 mg) reduced the analgesic effect of acetaminophen (1 g) in patients who had undergone abdominal hysterectomy; however, this reduction was in a short period of time. 40 The results of those human studies indicate that there is a questionable interaction between acetaminophen analgesia and 5-HT 3 blockers due to some conflicting results. Those conflicting results, showing a lack of obvious interaction, were mainly related to post-operative pain conditions.…”

Section: Role Of 5-ht 3 Receptorsmentioning

confidence: 99%

The Contribution of Serotonergic Receptors and Nitric Oxide Systems in the Analgesic Effect of Acetaminophen: An Overview of the Last Decade

Hamurtekin

Nouilati

Demirbatir

et al. 2020

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Yeşim HAMURTEKİN, Ammar NOUILATI, Cansu DEMİRBATIR, Emre HAMURTEKİN* Asetaminofen yaygın kullanılan analjezik ve antipiretik bir ajandır. Reçetesiz verilebilen formülasyonlarının da mevcudiyeti sık kullanımını artırmıştır. Günümüze kadar asetaminofenin analjezik etki mekanizmasını inceleyen bir çok çalışma bulunmaktadır. Santral sinir sisteminde siklooksijenaz yolağını inhibe etmesinin yanında, opioiderjik, kannabinoiderjik, dopaminerjik, kolinerjik ve nitrerjik sistemler kadar, bulbospinal serotonerjik yolaklar gibi analjezik etkili inen inhibitör yolakların da asetaminofenin analjezik etkisinde katkısı olan olası mekanizmalar olduğu önerilmiştir. Bu derlemede santral serotonerjik sistem ve santral sinir sistemindeki serotonerjik reseptör alt tiplerinin parasetamolün analjezik etkisine katkısını ortaya koyan verileri bir araya getirmeyi amaçladık. Bunu yaparken, esas olarak son on yılda yapılmış çalışmalara odaklandık ve önceki verilerle son eklenenler arasında bir bağlantı kurmaya çalıştık. Serotonerjik sistemin katkısına ek olarak, aynı zamanda son on yıldaki yeni bulgularla asetaminofenin ağrı kesici etkisinde nitrik oksidin rolünü de derledik. Anahtar kelimeler: Asetaminofen, serotonin, ağrı, nitrik oksit Acetaminophen is a widely used analgesic and antipyretic agent. It is also available in over the counter formulations, which has increased its wide use. There have been many studies to date that have aimed to evaluate the mechanism of the analgesic action of acetaminophen. Additional to the inhibition of the cyclooxygenase pathway in the central nervous system, the involvement of opioidergic, cannabinoidergic, dopaminergic, cholinergic, and nitrergic systems as well as the contribution of descending pain inhibitory systems like the bulbospinal serotonergic pathway has been proposed as possible mechanisms of the analgesic action of acetaminophen. In this review, we aimed to collect the data from studies revealing the contribution of the central serotonergic system and the role of central nervous system-located serotonergic receptor subtypes in the analgesic effect of acetaminophen. While doing this, we mainly focused on the research that has been performed in the last ten years and tried to link the previous data with the lately added results. In addition to serotonergic system involvement, we also reviewed the role of nitric oxide in the analgesic action of acetaminophen, especially with the new findings reported over the last decade.

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The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

Cited by 17 publications

References 25 publications

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

Esmolol does not improve quality of postsurgical recovery after ambulatory hysteroscopy

The Contribution of Serotonergic Receptors and Nitric Oxide Systems in the Analgesic Effect of Acetaminophen: An Overview of the Last Decade

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