مقایسه ی اثر اندانسترون و متوکلوپرامید در پیشگیری از تهوع و استفراغ بعد از عمل جراحی در بیماران بستری در بخش جراحی عمومی بیمارستان فارابی مشهد از سال 1386 تا سال 1387
Subject Areas : علوم پزشکی
Behruz Hushmand
1
(
)
Seyed Mohsen Ghasemi
2
(
)
Fatemeh Seyedi khabaz
3
(
)
Keywords: postoperative nausea and vomiting, ondansetron and metoclopramid,
Abstract :
BACKGROUND: Antiemetics currently in use are not totally effective.Serotonin receptor antagonists are a new class of antiemeticsthat have shown promise for treatment of nausea andvomiting in many situations. This study evaluates the efficacy of the Serotonin receptor antagonist, ondansetron,for the prevention of postoperative nausea and vomiting. METHODS: This randomized, double-blind study compared the efficacy of an intravenous dose of ondansetron 4 mg with metoclopramide 10 mg for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia for openabdominal surgery. A total of 126 patients (63 ondansetron, 63 metoclopramide), ASA status I–II, aged 18–65yr,were included and received study medication 30 minutes after the induction of anaesthesia and a standardized anesthetic technique and intraoperative analgesia were used in all patients. The proportion of patients experiencing emesis or nausea and the duration of nausea and the number of emetic episodes, were recorded during the 24-h period after surgery. RESULTS: During the overall observation period (0-24 h), significantly more patients who received ondansetron had no emetic episodes (87.3%) than those who received metoclopramide (73%, P = 0.044). A higher proportion of patients receiving ondansetron (71.4%) did not experience nausea (metoclopramide 63.5%, P=0.342). CONCLUSIONS: Ondansetron was superior to metoclopramide for preventionof vomiting in the first 24h after surgury and the total number of emetic episodes was reduced significantly compared with metoclopramide, but no significant differenceswere observed between ondansetron and metoclopramide for nauseacontrol or treatment failure.
1. Sherwood E, Williams CG, Prough DS. Anesthesiology principles, pain management and conscious sedation. In: Twnsend CM, Beauchamp RD, Evers BM, editors. Sabiston textbook of surgery.17th ed. Philadelphia: Elsevier Saunders; 2004.P.434.
2. Tulluk WC, Boucek CD, Cusano WA. Perioperative effects of anesthesia. In:Willmore DW, Cheung LY, HarkenAH, editors. ACS surgery principles & practice. 3d ed. New York: WebMD; 2002.p.614.
3. Dorian RS. Anesthesia of surgical patients. In: Brunicard FC, Andersen DK. Editors. Schwartz's principles of surgery. 8th ed. New York: MCgraw-Hill; 2005.P.1870.
4. Vander A, Shermer J, Luciano D. The digestion and absorption of food. In: Vander A, Shermer J, Luciano D. Human physiology: the mechanism of body function. 8th ed. New York: McGraw Hill; 2001. p.585.
5. Levy MN, Koeppen BN, Stanton BA. Motility of gastrointestinal tract. In: Levy MN, Koeppen BN, Stanton BA. BERNE & LEVY principles of physiology. 4th ed.. Philadelphia: Elsevier SaunderS; 2006. P.442-3.
6. Guyton AC, Hall JE. physiology of gastrointestinal disorders. In: Guyton AC, Hall JE. Text book of medical physiology. 11th ed.. Philadelphia: Elsevier Mosby; 2006. P823-4.
7. Islam S, Jain PN.Post-operative nausea and vomitting (PONV) : A review article. Indian J. Anaesth. 2004; 48 (4) : 253-258.
8. Sweetman S.C. Martindale: The complete drug reference. 35th ed. London: Pharmaceutical press. 2006. p.1526.
9. شهراز، سعید; غازیانی، طاهره. ایران فارما:درسنامه ی جامع داروهای رسمی ایران. چاپ چهارم. تهران: تیمورزاده. 1386.
10. Gan TJ, Apfel CC. A Randomized, Double-Blind Comparison of the NK1 Antagonist, Aprepitant, Versus Ondansetron for the Prevention of Postoperative Nausea and Vomiting. Anesth Analg 2007;104:1082-1089.
11. Wallenborn J, Gelbrich G, Burst D, Behrends K, Wallenborn H, Rohrbach A, Krause U, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone. BMJ 2006 Aug 12; 333 (7563): 324.
12. Aouad MT, Siddik-Sayyid SM, Taha SK, Azar MS, , Nasr VG, et al. Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery. Eur J Anaesthesiol. 2007 Feb;24(2):171-8.
13. Rust M. [Intravenous administration of ondansetron vs. metoclopramide for the prophylaxis of postoperative nausea and vomiting]. Anaesthesist. 1995 Apr;44(4):288-90.
14. Bugedo G, Gonzalez J, Asenjo C, De la Cuadra J, Gajardo A, Castillo L, Munoz H, et al. Ondansetron and droperidol in the prevention of postoperative nausea and vomiting. British Journal of Anaesthesia 1999, 83(5): 813-814.
15. Marcus JR, Few JW, Chao JD, Fine NA, Mustoe TA. The prevention of emesis in plastic surgery: a randomized, prospective study. Plast Reconstr Surg. 2002 Jun;109(7):2487-94.
16. Khalil SN, Kataria B, Pearson K, Conahan T, Kallar S, Zahl K, et al. Ondansetron prevents postoperative nausea and vomiting in women outpatients. Anesthesia & Analgesia 1994; 79(5): 845-851.
17. Sadhasivam S, Shende D, Madan R.Prophylactic ondansetron in prevention of postoperative nausea and vomiting following pediatric strabismus surgery: A dose-response study. Anesthesiology 2000; 92(4): 1035-1042.
18. Sanchez L, Lopez O, Pueyo F. J, Carrascosa F, OrtegaA. A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg 2002;95(6):1590-1595.
19/ Sharma S, Abdullah N. A comparison of commonly used anti-emetics for the prevention of emetic sequelae after a major gynaecological surgery. Singapore Med J 2000 Apr;41(4):147-50.
20/Pan PH, Moore CH. Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia. J Clin Anesth. 2001 Sep;13(6):430-5.
21/ Wilson EB, Bass CS, Abrameit W, Roberson R, Smith RW. Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy. Am J Surg. 2001 Feb;181(2):138-41
22/ Gan TJ, Collis R, Hetreed M. Double-blind comparison of ondansetron, droperidol and saline in the prevention of postoperative nausea and vomiting. Br J Anaesth. 1994 May;72(5):544-7.
23/ Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand. 2002 Jan;46(1):109-13.
24/ Sinha PK, Ambesh SP. Ondansetron in prophylaxis of postoperative nausea and vomiting in patients undergoing breast surgery: a placebo-controlled double blind study. J Indian Med Assoc. 2004 Feb;102(2):73-4, 76, 78-9.
25/ Maddali MM, Mathew J, Fahr J, Zarroug AW. Postoperative nausea and vomiting in diagnostic gynaecological laparoscopic procedures: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron. J Postgrad Med. 2003 Oct-Dec;49(4):302-6.
26/ Jokela R, Koivuranta M, Kangas-Saarela T, Purhonen S, Alahuhta S. Oral ondansetron, tropisetron or metoclopramide to prevent postoperative nausea and vomiting: a comparison in high-risk patients undergoing thyroid or parathyroid surgery. Acta Anaesthesiol Scand. 2002 May;46(5):519-24.
27/ Leksowski K, Peryga P, Szyca R. Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2006 May 11; [Epub ahead of print].
28/ Malins AF, Field JM, Nesling PM, Cooper GM. Nausea and vomiting after gynaecological laparoscopy: comparison of premedication with oral ondansetron, metoclopramide and placebo. Br J Anaesth. 1994 Feb;72(2):231-3.
29/ Pandey CK, Priye S, Ambesh SP, Singh S, Singh U, Singh Pk. Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized, double-blind, placebo-controlled study. J Postgrad Med. 2006 Apr;52(2):97-101.
30/ Kenny GN. Risk factors for postoperative nausea and vomiting. Anesthesia 1994; 49 (Suppl): 6-16.
