A comparative study of granisetrone, dexamethasone and combination of granisetrone-dexamethasone as prophylaxis for postoperative nausea vomiting during laparoscopic surgeries (original) (raw)
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Journal of Evolution of medical and Dental Sciences, 2015
BACKGROUND: Abdominal surgeries are associated with a very high rate of postoperative nausea and vomiting (PONV), which can lead to dehydration, electrolyte-imbalance, aspiration-pneumonitis and wound-dehiscence, thereby delaying patient’s recovery and prolonging hospital stay. OBJECTIVES: This study was designed to compare the effectiveness of granisetron alone and in combination with dexamethasone for prevention of PONV in patients undergoing general anesthesia for abdominal surgeries as well as recognizing the limitations of routine antiemetic prophylaxis with a multimodal approach to anti-emesis. MATERIALS & METHODS: In this prospective, randomized and controlled study 75 patients undergoing general anesthesia for abdominal surgeries were randomly allocated to one of the three groups of 25 patients each. Group G received granisetron 40μg/kg, group G+D received granisetron 40μg/kg+dexamethasone 0.1mg/kg and group C received normal saline intravenously, before induction of anesthe...
Introduction: The incidence of postoperative nausea and vomiting (PONV) following laparoscopic surgeries is very high without antiemetic prophylaxis. 5HT3 receptor antagonists are the most commonly used drug for prevention of PONV. Aims: To compare the effectiveness of intravenous (IV) Granisetron versus Ramosetron in prevention of PONV during the 24 hour period in patients undergoing laparoscopic surgeries. Materials and Methods: Sixty patients enrolled for the study were randomly allotted into two groups of thirty each. Group I received 1mg of IV Granisetron and Group II received 0.3 mg of IV Ramosetron, two minutes before induction of anaesthesia. Both the Groups were similar with respect to age, sex, duration and types of surgery and anaesthetic management. Patients were assessed for the incidence of nausea, retching, vomiting, need for rescue antiemetic and adverse effects at 0-2 hour and 2-24 hours interval following surgery. Students 't' test and chi-square test were used for comparing the parameters. A p-value <0.05 was considered significant. Results: There was no significant difference between the groups with respect to incidence of nausea, retching and vomiting. The incidence of nausea in group I at 0-2 hours was 3.3% and 6.7% in Group II without a statistically significant difference (p=0.5) and at 2-24 hour interval Group I had 3.3% while Group II had 10% incidence of vomiting with p=0.3 and statistically non-significant. There was no significant difference with respect to incidence of retching, vomiting, need for rescue antiemetic and adverse effects between the two groups. Conclusion: Both Granisetron and Ramosetron are equally effective in prevention of PONV in laparoscopic surgeries.
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND There is evidence that in patients with a high risk of developing Postoperative Nausea and Vomiting (PONV), combination of antiemetics is considered. The aim is to evaluate the effect of prophylactic dexamethasone and metoclopramide as monotherapy and in combination for female patients with moderate-to-high risk for PONV undergoing laparoscopic surgery under general anaesthesia. MATERIALS AND METHODS This was a multicentred, prospective, randomised, double-blind, placebo controlled trial. 120 patients, were allocated randomly to one of the four groups: (D) received 8 mg dexamethasone; (M) received 20 mg Metoclopramide; (C) received dexamethasone (8 mg) and metoclopramide (20 mg); and (P) received saline. All patients were assessed 24 hours for PONV, postoperative symptoms and the need for rescue antiemetic and analgesia. RESULTS In the 24-hour post-operative period, the following results were demonstrated; Significant differences in the incidence of vomiting between placebo group 17 patients (56.7%) and combination group 6 (20%), P = 0.0037, and dexamethasone group 6 (20%), P = 0.0037. The results indicate that incidence of overall vomiting was reduced by use of either Dexamethasone or combination. Also statistically significant differences were noted in the incidence of nausea between the treatment groups [D 6 (20%); M 10 (33.3%); and C 5 (16.7%)] when compared with placebo 19 (63.3%), p< 0.05. The results indicate that the three treatments groups have similar effect in reducing overall incidence of nausea. Significant differences were also exhibited in the intensity of nausea between the combination group 1.05 (± 0.90) compared with dexamethasone 1.78 (± 1.14), P = 0.008, Metoclopramide 2.43 (± 1.03), P = 0.000 and placebo 3.07 (± 1.34), P=0.000. Results demonstrate that using a combination can significantly reduce the intensity of nausea. The total number of patients who received rescue antiemetic in combination 6 (20%) and dexamethasone 7 (23.3%) were significantly lower than those receiving placebo 19 (63.3%), p <0.05. Incidence, intensity of pain and the consumption of rescue analgesic were reduced significantly in the combination and dexamethasone groups compared with Metoclopramide and Placebo. CONCLUSION The combination of dexamethasone plus metoclopramide reduces the intensity of nausea. Dexamethasone and a Dexamethasone plus Metoclopramide was found more effective in preventing PONV and decreasing the requirement of rescue antiemetic than Metoclopramide or placebo. Patients who are at high risk for PONV may demonstrate positive outcomes when using a combination therapy.
2008
Background: Postoperative nausea and vomiting (PONV) is common after anaesthesia and surgery. We decided to evaluate metoclopramide, dexamethasone, and their combination in preventing PONV in patients undergoing laparoscopic surgery. Method: 396 patients were studied. Four groups were created: group 1 received metoclopramide postoperatively; group 2 received dexamethasone following anaesthesia; and group 3 received dexamethasone following anaesthesia and metoclopramide before end of anaesthesia. Results were compared to group without anti-emetic. PONV incidence, basal and active mean visual analogue pain scores, time to first analgesia request, side effects, and well-being score were recorded at first 24 h postoperatively. Results: Literature total incidence of PONV was 60% in control group devoid of anti-emetic but 45% of PONV was seen in Group 1 with metoclopramide, Group 2 -23% with dexamethasone, and Group 3 -12% with the combination of dexamethasone and metoclopramide. Anti-emetic rescue was not required in dexamethasone plus metoclopramide group or group with only dexamethasone, compared with four patients in the metoclopramide group and six patients in the control group. Conclusion: Dexamethasone or dexamethasone + metoclopramide combination was more effective in preventing PONV than metoclopramide or lack of anti-emetic.
International Journal of Research in Medical Sciences, 2016
Despite advances in anaesthesia care postoperative nausea and vomiting (PONV) remains a vexing problem. PONV is distressing adverse effect after anaesthesia and surgery, resulting in significant morbidity due to acute discomfort associated with emetic symptoms and longer stays in the recovery room or unexpected hospital admission in ambulatory settings. Patients reports that avoidance of PONV is of greater or equal concern as avoidance of postoperative pain and they are willing to ABSTRACT Background: Postoperative nausea and vomiting (PONV) remains a vexing problem despite of advances in anaesthesia care. PONV is distressing adverse effect after anaesthesia and surgery, resulting in significant morbidity due to acute discomfort associated with emetic symptoms and longer stays in the recovery room or unexpected hospital admission in ambulatory settings. Methods: A prospective, randomized, double blind comparative study was conducted to compare the efficacy and adverse effects of injection granisetron 40µg/kg as a single dose and injection granisetron in two different doses (20µg/kg and 40µg/kg) in combination with dexamethasone 160µg/kg for prevention of postoperative nausea and vomiting in patients undergoing general anaesthesia for elective laparoscopic cholecystectomy. Results: Nausea and vomiting were observed postoperatively at 0, 1, 2, 4, 8, and 24 consecutive hours after patient responded to verbal commands. Intensity of nausea graded verbally with an eleven point score (0-10) with those patients who scored their nausea as zero were termed nausea free, and 10 being most severe. Nausea scores when patient complains of nausea & if patient demand rescue antiemetic for nausea was noted down along with adverse effects if any. The data was analysed by ANOVA followed by unpaired't' test, Chi-square/Fischer exact test or Kruskal Wallis Test. Conclusions: Granisetron as a single agent in dose 40µg/kg is effective as prophylactic antiemetic in preventing PONV in laparoscopic cholecystectomy whereas addition of dexamethasone 160µg/kg to granisetron significantly increases antiemetic efficacy of the granisetron in both the doses i.e. 20µg/kg and 40µg/kg without increasing any side effect. Granisetron 40µg//kg+injection dexamethasone 160µg/kg is best for antiemetic prophylaxis in highly emetogenic surgeries like laparoscopic cholecystectomy. Granisetron 20µg/kg + injection dexamethasone can be cost effective alternative for routine antiemetic prophylaxis compared to granisetron 40µg//kg and granisetron 40µg//kg+ injection dexamethasone for all patients undergoing laparoscopic cholecystectomy.
Middle East journal of anaesthesiology, 2010
In a prospective randomized double-blind study, we compared the effectiveness of dexamethasone 8 mg with either granisetron 1 mg or ondansetron 4 mg in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery. Hundred ASA I and II patients scheduled for laparoscopic surgery were enrolled in the study and 84 patients completed it. Following induction of anesthesia, group I (n=42) received granisetron 1 mg and dexamethasone 8 mg, group II (n=42) received ondansetron 4 mg and dexamethasone 8 mg. Nausea and vomiting episodes, pain scores as well as side effects were recorded during the first hour and subsequently during the first 6 and 24 hours postoperatively. Satisfaction scores were obtained at discharge. There was no statistically significant difference between the 2 groups during the 1st 24 hours following surgery in regards to pain scores, satisfaction and side effects manifestations. At 0-1 hour interval, 100% of patients in group I and 97.6...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Postoperative Nausea and Vomiting (PONV) are the most unpleasant side effects after surgery. The incidence of PONV after laparoscopic surgery is high (40-75%). The purpose of this study was to prospectively evaluate the efficacy of granisetron, ramosetron and palonosetron for the prevention of PONV in patients undergoing laparoscopic surgery. METHODS In this prospective, randomized observational study, 90 healthy patients who were undergoing abdominal laparoscopic surgery under general anaesthesia were enrolled. Patients were divided into three groups. Group A received Inj. granisetron (1 mg), group B received Inj. ramosetron (0.3 mg), and Group C received Inj. palonosetron (0.075 mg) intravenously five minutes before induction of anaesthesia. The incidence of nausea, vomiting, retching, rescue antiemetic requirements and complete response during the first 24 h after surgery were evaluated. RESULTS The number of complete responders during 0-4 h were 24 (80.00%) for Palonosetron, 23 (76.67%) for Ramosetron and 21 (70.00%) for Granisetron, which was statistically nonsignificant. During 4-12 h number of complete responders were 26 (86.67%) for Palonosetron, 25 (83.33%) for Ramosetron and 22 (73.33%) for Granisetron representing a significant difference (p=0.021) between Granisetron and Palonosetron, while Granisetron vs Ramosetron (p=0.092) and Ramosetron vs Palonosetron (p=0.513) showed non-significant differences. Similarly, during 12-24 h number of complete responders were 28 (93.00%) for Palonosetron, 26 (86.67%) for Ramosetron and 24 (80.00%) for Granisetron representing a significant difference (p=0.011) between Granisetron and Palonosetron. The incidence of PONV during 4-12 h and 12-24 h also showed a significant difference between Granisetron and Palonosetron. CONCLUSIONS The antiemetic effect of Palonosetron is better than Granisetron, whereas there was no significant difference in the antiemetic efficacy of Granisetron and Ramosetron as well as between Ramosetron and Palonosetron in patients undergoing laparoscopic surgery.
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2009
Purpose Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common problems after surgery. Prophylactic combination antiemetic therapy is recommended for patients at high risk for developing PONV and PDNV. Granisetron, a serotonin antagonist, is an effective antiemetic that is devoid of sedative side effect. Although promethazine is effective, commonly used doses are associated with sedation. This study investigates the combination of low doses of granisetron and promethazine for the prevention of PONV. Methods Women undergoing ambulatory gynecological laparoscopy were enrolled. A standard general anesthetic regimen was prescribed. Fifteen minutes before the expected end of surgery, the patients were randomly assigned to receive granisetron 0.1 mg iv, promethazine 6.25 mg iv, or a combination of the two drugs. Prophylaxis with oral promethazine 12.5 mg, granisetron 1 mg, or both was started in the respective groups 12 hr after the end of surgery and continued every 12 hr until postoperative day 3 (a total of five oral doses). The following outcomes were recorded: total response rate (defined as no vomiting, no more than mild nausea, and no use of rescue antiemetic); incidence of nausea, vomiting, and use of rescue antiemetics; severity of nausea; patient activity level; and patient satisfaction with PONV management. Results Patients in the combination group had a higher total response rate at 6, 24, 48, and 72 hr after surgery compared with those who received promethazine alone (at 24 hr, Combination 69.6%, Promethazine 36.2%, Granisetron 53.3%; P = 0.0079). The maximum nausea scores were also lower in the combination group at 6, 24, 48, and 72 hr (Combination 1.7 ± 2.2, Promethazine 4.0 ± 3.6, Granisetron 3.1 ± 3.2 at 24 hr; P \ 0.05). There was no difference in the sedation scores, incidence of drowsiness, patient activity level, and satisfaction with PONV management. Conclusions Low-dose granisetron and promethazine combination was more effective in reducing PONV and PDNV than promethazine monotherapy. The combination also reduced the severity of nausea. Résumé Objectif Les nause´es et vomissements postope´ratoires (NVPO) et les nause´es et vomissements apre`s le conge´sont des proble`mes courants a`la suite d'une chirurgie. Un traitement antie´me´tique combine´prophylactique est recommande´chez les patients pre´sentant un risque e´leve´de NVPO et de nause´es et vomissements apre`s le conge´. Le
Scholars Journal of Applied Medical Sciences, 2020
Original Research Article Objective: In this study our main goal is to comparison of the effectiveness of metoclopramide combined with dexamethasone and granisetron alone in preventing post-operative nausea and vomiting in high risk patients undergoing laparoscopic cholecystectomy. Method: It is a cross sectional observational study on 120 patients who underwent laparoscopic cholecystectomy. The study period was July, 2017 to June, 2018. The study was conducted in the department of Anesthesia, Analgesia and Intensive care medicine of BSMMU. All the patients were chosen by purposive sampling. The study population was divided into two groups by simple lottery method. Group A patients got Granisetron (1mg iv single dose) and Group B patients got Metoclopramide and Dexamethason (Inj. Metoclopramide (10mg) and Inj. Dexamethasone (8mg)) just before induction. The observations were plotted into tabular and figure form. The categorical variable was analyzed by chi square test and the quantitative variables were analyzed by unpaired student's t test. Results: The mean age of Group A and B patients were 33.73±6.97 and 34.62±7.16 years respectively. The sex ratio showed 21:39 and 15:45 in case of Male: Female respectively.out of 60 patients in each group PONV was reported in 20 (33.33%) and 16(26.67%) patients in Group A and Group B respectively. No PONV was reported in 40 (66.67%) and 44 (73.33%) patients in Group A and B respectively. 40(66.67%) and 44(73.33%) in Group A and B respectively showed no nausea and vomiting. 8(13.33%) and 7(11.67%) patients showed score 1 (nausea) in Group A and B respectively. On the contrary, 7(11.67%) and 5(8.33%) patients in Group-A and B respectively were categorized PONV score 2 (who experienced both nausea and vomiting. Only 5(8.33%) and 4(6.67%) patients experienced repeated vomiting ≥2 times who were categorized as PONV score 3.(p= 0.872). Among rescue antiemetic drug, analgesic drug use and postoperative hospital stay nothing but the hospital stay showed the statistically significant difference between the groups (P=0.000044). Conclusion: From our results we can conclude that, no statistically significant difference was observed between metoclopramide combined with dexamethasone group and granisetron alone except the granisetron from the point of view of short hospital stay.