Intravenous Granisetron, Ondansetron and Metoclopramide in the Prevention and Treatment of Post Operative Nausea and Vomiting after Laparoscopic Cholecystectomy - A Comparative Study

Abstract

Postoperative nausea and vomiting are the common morbidity after general anaesthesia and surgery. One of the essential goals of anaesthetic management is to prevent postoperative nausea and vomiting. The consequence of prolonged postoperative nausea and vomiting (PONV) ranges from unexpected admission of day patients with its economic implications to physical, metabolic and psychological effects on the patients which slow their recovery and reduced their confidence in future surgery and anaesthesia.

The present study was designed to compare the efficacy of Granisetron with that of Ondansetron and Metoclopramide in the treatment and prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. This study was also done to observe the incidence of nausea and vomiting in the postoperative period, to observe the requirement of rescue antiemetic, to find out the haemodynamic stability, saturation of arterial oxygen in these groups of subject and to detect the patients satisfaction by verbal rating scale after 24 hours of surgery.

A total number of 90 patients, sex female, age range 30-50 years undergoing laparoscopic cholecystectomy were selected. They were equally divided into three groups of 30 patients. They received a standard general anaesthesia. Group I received injection Granisetron (1mg), Group II received injection Ondansetron (8mg), Group III received injection Metoclopramide (10mg) 10 minutes before reversal of anaesthesia. Postoperative analgesia was provided with injection pethidine (1.5mg/kg/bd.wt.) intramuscularly 8 hourly.

In the recovery room occurrence of nausea and vomiting was assessed for 24 hours. The incidence of emesis free (no nausea) was significantly higher in patients who received Ganisetron (90.0%, 27/ 30) than in those who received Ondansetron [(66.7%, 20/30), p=0.028] or metoclopramide [(40.0%, 12/30), p= 0.000].The incidence of vomiting free was significantly higher in patients who received Granisetron (93.3%, 28/30) than in those who received Ondansetron [73.3%, 22/30), p= 0.037] or Metoclopramide [46.7%, 14/30), p= 0.000]. Granisetron was associated with greater patients' satisfaction than Ondansetron and Metoclopramide 40%, 20% and 10% of patients respectively. No need for another rescue antiemetic medication was achieved in 86.7% of patients with granisetron, 70.60% with Ondansetron and 53.3% with Metoclorpramide. The haemodynamic variables, heart rate, blood pressure, SpO₂ were recorded carefully in different time intervals. There was no significant difference among the study. So, it can be concluded that Granisetron is more effective than Ondansetron and Metoclopramide in the prevention and treatment of postoperative nausea and vomiting after laparoscopic cholecystectomy.

Journal of BSA, Vol. 19, No. 1 & 2, 2006 p20-27