COMPARISON OF METOCLOPRAMIDE, PROCHLORPERAZINE AND PLACEBO IN PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING (PONV) FOLLOWING TONSILLECTOMY IN YOUNG ADULTS
AbstractBackground: Postoperative nausea and vomiting following anaesthesia and surgery are commonand can create considerable problems regarding management of patients and outcome of thesurgical procedure. Methods: This study evaluates and compares the efficacy and safety of themetochlopramide to that of prochlorperazine in the prevention of postoperative nausea andvomiting after tonsillectomy in young adult patients. 150 patients, of either sex, undergoingtonsillectomy under the same anaesthetic technique were studied in a randomized, double blind,placebo controlled manner. Either metoclopramide 0.1-0.2 mg kg-1, prochlorperazine 0.1-0.2 mgkg -1 or 5% Dextose and normal saline (5% D/N.S) (2ml) as placebo was injected intravenously 10minutes before induction of general anaesthesia. Episodes of nausea, retching/ vomiting, adverseevents, vital signs, the need for rescue antiemetic drug ( metoclopramide 0.1-0.2 mg kg–1 IV) wererecorded until four hours from the end of the surgical procedure. Results: The overall frequencyof PONV was 18%, 16%, and 24% in group A (metoclopramide), B (prochlorperazine) and C(placebo) respectively. The need for rescue antiemetic was 2%, 8% and 12% in Prochloperazinegroup, metoclopramide group and control group respectively. These differences did not reachstatistical significance (P>0.05). During the study period 82%, 84% and 76% of patients in groupA, B and C respectively were found free from postoperative nausea and vomiting, and no adverseevents related to either of the test medication were noted in any patient. Conclusion: It isconcluded that the differences in the results of occurrence of PONV in the experimental group andcontrol group are not statistically significant. However either Prochloperazine 0.1 – 0.2 mg kg-1 ormetoclopramide 0.1 – 0.2 mg kg-1 can be safely administered as Prophylactic antiemetic till theavailability of more efficacious and safe antiemetic drugs.Keywords: Postoperative nausea and vomiting (PONV), metoclopramide, prochlorperazine,tonsillectomy.
Watch MF, White PF. Postoperative nausea and
vomiting, its etology, treatment and prevention
Anesthesiology 1992; 77; 162-84.
Beattie WS, Lindblad T, Buckley DN, Forrest JB.
Mensturation increases the risk of nausea and vomiting
after laparoscopy, a prospective randomized study
Anesthesiology 1993;78; 272-76.
Lerman J. Surgical and patient factor involved
postoperative nausea and vomiting Br J Anaesth
Kamath B, Curran J, Hawkey C. Anaesthesia,
movement and emesis. Br J Anaesth 1990; 64; 728-30.
Andrews PLR. Physiology of nausea and vomiting Br J
Anaesth 1992; 69 (Supply -1); 2S-19S.
Bremner WGM, Kumar CM. Delayed surgical
emphysema Pneumomediastinum and bilateral
pneumothoraces after postoperative vomiting Br J
Anaesth 1993; 71:296-7.
Capouet V, De Pauw C, Vernet B. Single dose i, v
tropisetron in the prevention of postoperative nausea
and vomiting after gynecological surgery, Br J Anaesth
Shenkman Ze’ EV, Holzman RS, Kim E. AcupressureAcupuncture Antiemetic prophylaxes in children under
going Toxsillectomy Anesthesiology 1999; 90; 1311-6.
Florio TD. The use of midazolam for persistent
postoperative nausea and vomiting Anaesth Intensive
Care 1992; 20; 383-86.
Bowhayar, Mayha, Rudnicka AR. A randomized
controlled trail of the antiemetic effect of three doses of
ondansetron after strabismus surgery in children. Paed
Anaesth 2001; 11; 215-21.
Madej TH, Simpson KH. Comparison of the use of
domperidone, droperidol and metoclopramide in the
prevention of nausea and vomiting following major
metoclopramide surgery. Br J Anaesth 1986;58;884-7.
Tramer M, Moore A, McQuay H. Prevention of
vomiting after paediatirc strabismus surgery, a
systematic review using review using the numbers
needed to treat method. Br J Anaesth 1995;75:556-61.
Buther M, Walder B, Elm Fvetal. Is lower dose
haloperidol a useful antiemetic. A Meta-analysis of
published and unpublished Randomized trials.
Van den Berg AA. Comparison of ondansetron and
prochloperazine for the prevention of nausea and
vomiting after adenotosillectiomy. Canjanaesth
Knapp MR, Beecher HK. Postanaesthetic nausea,
vomiting and retching. JAMA 1956;160;376-85.
Bone Me, Wilkinson DJ, Young JR, McNeil J,
Charltron S. Ginger root a new antiemetic. The effect of
ginger root on postoperative nausea and vomiting after
major Gyneacological surgery. Anaesthesia
Honkavaara P. Effect of transdermal hyoscine on
nausea and vomiting during and after ear surgery under
local anesthesia. Br J Anaesth 1996;76:49-53.
Khan FA. Soomro NA, Kamal RS. A review of 6978
consecutive admission to the recovery room at a
university hospital J Pak Med Assoc 1991;41:2-6
Mckenzie R, Kovac A, Connor TO. Comparison of
ondansetron versus placebo to prevent postoperative
nausea and vomiting in woman undergoing ambulatory
gynaecologic surgery. Anesthesiology 1993;78:21-8.
Raphael JH, Norton AC. Antiemetic efficacy of
prophylactic ondansetron in laparoscopic surgery.
Randomized, double-blind comparison with
metoclopramide. Br J Anaesth 1993;71:845-8.
Rudra A. Comparison of ondansetron, metoclopramide
and placebo in the prevention of emetic episodes
following Cholecystectomy. Anesthesiology 1993;