The Prophylaxis and Treatment with Ondansetron for Postoperative Nausea and Vomiting

Abstract

Objective: Postoperative nausea and vomiting (PONV) is the common complication of patients undergoing laparoscopic cholecystectomy (LC). Aim of this study is to determine the efficacy of ondansetron for PONV after LC and exploring the most effective time of using it. Methods: The clinic data of 120 patients with chronic cholecystitis (selected randomly from all the patients undergone LC at the Second Affiliated Hospital of Chongqing Medical University between 2012 and 2014) were analyzed retrospectively. The data were divided into three groups: the preoperative group (n=40), postoperative group (n=40) and control group (n=40). The preoperative group received 8 mg of ondansetron intravenously 30 minutes prior to the induction of anesthesia while the postoperative group received 8 mg of ondansetron intravenously when anaesthesia recovery, the control group received no antiemetic. The incidence of PONV and the adverse effects during the postoperative periods (48 hrs) were recorded in the data. If the PONV happened, the patients received 8mg of ondansetron intravenous again. Results: Significant differences were found between the preoperative group and postoperative group (preoperative: 27.5% vs. postoperative group: 10%) and the preoperative group and control group (preoperative: 27.5% vs. control group: 50%). To the PONV case, using ondansetron intravenous again about 88% got control. No clinically important adverse effects were noted. Conclusion: Administration of ondansetron is effective in the prevention and cure of PONV for LC. Late administration (anaesthesia recovery) is significantly more effective.

Decrease in Incidence of PONV by using Ondansetron as Preemptive Antiemetic Agent in Liver Donors

“…Our observation is in line with a similar previous study where Zhang et al 11 (2013) evaluated the role of ondansetron in patients undergoing laparoscopic gynecological surgery and reported that ondansetron considerably reduced the incidence of post-operative nausea (30.0% vs. 55.0%; p-value<0.05) and vomiting (27.5% vs. 55.0%; p-value<0.05) as compared to controls. In another similar trial conducted in patients undergoing general abdominal surgery, Yu et al 14 (2015) also reported similar reduced incidence of vomiting after prophylactic administration of ondansetron (27.5% vs. 50.0%; p-value<0.05) . Similar beneficial effect of preemptive ondansetron has also been reported by Sinha et al 15 in 2004 (20.0% vs. 60.0%; p-value<0.05) and Larijani et al 16 in 1991 (22.0% vs. 72.0%; p-value<0.001) in terms of postoperative vomiting.…”

Preoperative versus intraoperative antiemetic strategies in patients undergoing laparoscopic cholecystectomy

“…The incidence of postoperative nausea or vomiting was higher in patients who received ondansetron just before induction of anaesthesia compared with patients who received the drug shortly before the end of surgery (30 versus 20% and 17 versus 8% for nausea and vomiting, respectively). 18 In a retrospective study of patients undergoing laparoscopic cholecystectomy, 19 8 mg of ondansetron given intravenously during recovery from anaesthesia was associated with a lower incidence of PONV (10%) compared with ondansetron given 30 min before induction of anaesthesia (27%).…”

“…These findings are not consistent with those of some other investigations. [17][18][19][20] In a randomised, double-blind, placebo-controlled study, 50 patients undergoing otolaryngological surgery received 4 mg of ondansetron intravenously either before induction of anaesthesia or at the end of surgery a third group of 25 patients served as control. 20 Ondansetron given at the end of surgery significantly reduced the need for rescue antiemetics in the PACU but at 24 h, the incidence of nausea, vomiting and antiemetic requirements did not differ between the three groups.…”

“…13 Two of the eight studies we found are powered regarding sample size calculation, 17,20 seven are randomised controlled trials, [13][14][15][16][17][18]20 four of them are reported as blind, 15,17,18,20 and one study is retrospective. 19 In five studies, no difference was found in PONV incidence when ondansetron was administered before induction of anaesthesia or at the end of surgery, [13][14][15][16]18 but in one study, ondansetron when given preventively was associated with less antiemetic consumption. 20 In three studies, the incidence of PONV was lower when ondansetron was given at the end of surgery.…”

“…[13][14][15][16] In other trials, investigators reported that late administration of ondansetron is more effective, and the drug should be administered at the end of surgery rather than before induction of anaesthesia. [17][18][19] However, most studies had flaws related to randomisation, blinding, data analysis and sample size calculation; therefore, we designed and conducted the present study.…”