Ondansetron versus droperidol or placebo to prevent nausea and vomiting after otologic surgery

This study compares the preoperative administration of ondansetron with that of droperidol or saline solution for the prevention of nausea and vomiting in otologic surgery patients. A total of 120 otherwise healthy individuals were randomly assigned to receive either saline solution, ondansetron (4 mg intravenously), or droperidol (25 microg/kg intravenously) before anesthetic induction. Intraoperative and postanesthesia care unit times were recorded along with incidence of nausea, vomiting, pain, nausea and recovery scores, and the administration of rescue antiemetics. Similar assessments were made during the next 24 hours. Demographics were similar, but more males received ondansetron. Anesthetic recovery scores were lower after administration of droperidol than after ondansetron. Incidence of nausea was similar between groups, but severity was greater with placebo and droperidol than with ondansetron. More vomiting occurred with placebo than with ondansetron or droperidol. No intergroup differences in rescue antiemetic administration were noted, however. Twenty-four hours later, more patients receiving placebo had nausea or vomited than patients receiving droperidol or ondansetron. Fewer women in the ondansetron group vomited than in the other two groups. Ondansetron 4 mg intravenously is as effective as droperidol and better than saline solution in preventing nausea and vomiting in patients undergoing otologic surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter postanesthesia care unit times was noted after ondansetron therapy.     

Ontogenic development of the adenylyl cyclase enzyme and the alpha s, alpha i1 and alpha i2 G-protein regulatory subunits from rat prostate

STUDY OBJECTIVE: To compare the prophylactic administration of ondansetron with droperidol or placebo to determine its effectiveness in reducing postoperative nausea and vomiting after middle ear procedures. DESIGN: Prospective, randomized, double-blind study. SETTING: Inpatient otolaryngology service at a university medical center. PATIENTS: 120 ASA physical status I and II patients presenting for elective middle ear surgical procedures. INTERVENTIONS: Patients were randomly assigned to receive either placebo (Group 1), ondansetron 4 mg intravenously (IV) (Group 2), or droperidol 25 mcg/kg i.v. (Group 3) 10 minutes before induction of general anesthesia using thiopental 5 mg/kg i.v. with fentanyl 2 mcg/kg i.v. and maintenance anesthesia with isoflurane 1% to 2% end-tidal in a 50% air/oxygen mixture. MEASUREMENTS AND MAIN RESULTS: Total surgical, anesthesia, extubation, and postanesthesia care unit (PACU) occupancy times were recorded along with anesthesia recovery scores. The incidence and severity of nausea, vomiting, and pain along with rescue antiemetic administration, also were recorded. Similar assessments were made over the next 24 hours. Intergroup demographic data were similar except that the male to female ratio was higher in the ondansetron group. Stewart scores, reflecting emergence from anesthesia, were higher with ondansetron compared with droperidol. The incidence of nausea was similar between the groups but the severity was less after ondansetron therapy. More patients vomited after placebo than when given either droperidol or ondansetron. No intergroup differences were noted in the use of rescue antiemetics. Twenty-four hours later, more patients who received the placebo drug had nausea or vomited compared with either ondansetron or droperidol. CONCLUSIONS: Ondansetron 4 mg i.v. is as effective as droperidol and better than placebo in preventing nausea and vomiting in patients undergoing middle ear surgery. No cost advantage as determined by lower use of rescue antiemetics or shorter PACU times was noted after the prophylactic administration of ondansetron.     

Oral ondansetron for the control of cisplatin-induced delayed emesis: a large, multicenter, double-blind, randomized comparative trial of ondansetron versus placebo

PURPOSE: To investigate the efficacy and safety of oral ondansetron in the control of cisplatin-induced delayed emesis in patients who do not require rescue antiemetic therapy for acute emesis. PATIENTS AND METHODS: Five hundred thirty-eight chemotherapy-naive patients who received cisplatin chemotherapy (> or = 70 mg/m2), and who were not rescued for acute emesis, were eligible to be randomized to receive one of the three oral regimens to control delayed emesis. Group I received placebo on days 2 to 6; group II received ondansetron 8 mg twice daily on days 2 and 3 and placebo on days 4 to 6; group III received ondansetron 8 mg twice daily on days 2 to 6. All patients received intravenous ondansetron (0.15 mg/kg every 4 hours for three doses) for the control of acute emesis on day 1. The number of emetic episodes on days 2 and 3 combined (days 2/3, when incidence and severity of delayed emesis were expected to be greatest) was considered the primary measure of efficacy. RESULTS: Patients who received odansetron had significantly fewer emetic episodes on days 2/3, 4, and 5 than those who received placebo (P < or = .002 on each day). Additionally, significantly more patients who received ondansetron had a complete plus major response (C+MR; < or = two two emetic episodes) than those who received placebo on days 2/3 (56% v 37%, P = .001), 4 (94% v 85%, P = .005), and 5 (98% v 88%, P = .006). Patients who received ondansetron had significantly less nausea on day 2/3 when day-1 nausea was used as the baseline score (P = .025). Patients who received ondansetron also had significantly less nausea on day 4 (P = .042) and the results approached significance on day 5 (P = .066). CONCLUSION: Oral ondansetron had a significant effect in the control of cisplatin-induced delayed emesis and nausea in patients who had not required rescue antiemetics during the acute emesis period. The control of delayed nausea and vomiting was most notable in the immediate 2 days following cisplatin administration, with the clinical difference narrowing between the two treatment arms on subsequent days.     

Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials

OBJECTIVE: The authors reviewed efficacy and safety data for ondansetron for preventing postoperative nausea and vomiting (PONV). METHODS: Systematically searched, randomized, controlled trials (obtained through MEDLINE, EMBASE, Biological Abstracts, manufacturer's database, manual searching of journals, and article reference lists) were analyzed. Relevant end points were prevention of early PONV (within 6 h after surgery) and late PONV (within 48 h) and adverse effects. Relative benefit and number-needed-to-treat were calculated. The number-needed-to-treat indicated how many patients had to be exposed to ondansetron to prevent PONV in one of them who would have vomited or been nauseated had he or she received placebo. RESULTS: Fifty-three trials were found that had data from 7,177 patients receiving 24 different ondansetron regimens and from 5,712 controls receiving placebo or no treatment. Average early and late PONV incidences without ondansetron were 40% and 60%, respectively. There was a dose response for oral and intravenous ondansetron. Best number-needed-to-treat to prevent PONV with the best documented regimens was between 5 and 6. This was achieved with an intravenous dose of 8 mg and an oral dose of 16 mg. Antivomiting efficacy was consistently better than antinausea efficacy. Efficacy in children was poorly documented. Ondansetron significantly increased the risk for elevated liver enzymes (number-needed-to-harm was 31) and headache (number-needed-to-harm was 36). CONCLUSIONS: If the risk of PONV is very high, for every 100 patients receiving an adequate dose of ondansetron 20 patients will not vomit who would have vomited had they received placebo. The antinausea effect is less pronounced. Of these 100, three will have elevated liver enzymes and three will have a headache who would not have had these adverse effects without the drug.     

Antiemetic efficacy of prophylactic ondansetron in laparoscopic surgery: randomized, double-blind comparison with metoclopramide

In a randomized, double-blind study, we have compared the prophylactic antiemetic efficacy of ondansetron with that of metoclopramide in 123 patients undergoing general anaesthesia for day-case gynaecological laparoscopic surgery. The patients received either i.v. ondansetron 4 mg or metoclopramide 10 mg immediately before a standard anaesthetic. The number of patients with no nausea or vomiting in the ondansteron group was 50 (82%) compared with 29 (47%) in the metoclopramide group (P < 0.001). In those patients with a previous history of postoperative nausea and vomiting, nausea was less severe in those receiving ondansetron compared with those receiving metoclopramide (P < 0.05). We conclude that preoperative prophylactic administration of i.v. ondansetron was superior to metoclopramide in preventing nausea and vomiting after general anaesthesia for day-case gynaecological laparoscopic surgery.     

Prophylactic administration of ondansetron in emergency intraabdominal operations

Efficiency of ondansetron, a selective 5-HT3 receptor antagonist, in prevention of postoperative nausea and vomiting in 40 ASA I-II patients who will undergo emergency intraabdominal operations is studied in a randomized double-blind and placebo controlled study. Patients of no premedication are administered 4 mg i.v. ondansetron or placebo (saline) before induction. Thiopental (4 mg/kg) was used for induction, succinylcholine (2 mg/kg) for muscular relaxation, and 50% nitrous oxide in oxygen and isoflurance (0.8-1.5%) for the maintenance of anesthesia, and fentanyl and norcuron were administered when necessary. Vital signs were closely monitored and recorded during anesthesia and early postoperative period. Study is carried out during postoperative 0-1 h, 1-2 h and 2-24 h periods. Nausea scores and emesis were recorded during 0-1 and 1-2 h periods. Ondansetron was found significantly more effective than placebo (p < 0.05 and p < 0.05). Although is was effective during 2-24 h period, the difference was not statistically significant (p > 0.05). No significant difference was observed between the groups in terms of vital findings, laboratory findings and side effects (p > 0.05). Therefore it is concluded that administration of prophylactic i.v. ondansetron to patients undergoing emergency intraabdominal operations is effective in prevention of nausea and vomiting without any significant side effects.     

Vomiting after adenotonsillectomy in children: a comparison of ondansetron, dimenhydrinate, and placebo

We compared the effectiveness of ondansetron, dimenhydrinate, and placebo for the prevention of postoperative vomiting in children after adenotonsillectomy. In a randomized, placebo-controlled, double-blind study, 74 children, 2-10 yr of age scheduled for adenotonsillectomy as outpatients were given a single i.v. dose of ondansetron (0.1 mg/kg, n = 26), dimenhydrinate (0.5 mg/kg, n = 25), or placebo (saline, n = 23) at induction of anesthesia. The incidence of retching and vomiting (POV) and side effects observed 24 h after surgery were recorded. Demographic data were similar among the three groups. The 24-h incidence of POV was 42%, 79%, and 82% in the ondansetron, dimenhydrinate, and placebo groups, respectively (ondansetron compared with dimenhydrinate [P < 0.02] or placebo [P < 0.01]). The study was stopped after two children vomited large volumes of bloody fluid 9 and 22 h after surgery without previous signs of occult bleeding. Both children had received ondansetron. We conclude that ondansetron is superior to dimenhydrinate or placebo for the prevention of POV after adenotonsillectomy in children. Antiemetics may mask the signs of bleeding after adenotonsillectomy. IMPLICATIONS: I.v. ondansetron (0.1 mg/kg) is more effective than both dimenhydrinate and placebo in preventing vomiting after adenotonsillectomy in healthy children. However, antiemetics may also mask the presence of blood in the stomach by preventing vomiting, and this should be appreciated when adenotonsillectomy is performed on an outpatient basis.     

Propofol anaesthesia and vomiting after myringoplasty in children

To determine whether propofol anaesthesia reduces the incidence of nausea and vomiting after ear surgery, 40 children aged 4-16 years were randomly assigned to receive either propofol or inhalational anaesthesia. Children in the propofol group had anaesthesia induced with propofol and maintained with propofol-nitrous oxide and those in the inhalational group had anaesthesia induced with thiopentone and maintained with isoflurane-nitrous oxide. Nausea and vomiting were recorded for 24 h after surgery and metoclopramide was offered to children who vomited more than twice. We found that 11 children (55%) who had propofol and 14 children (70%) who had inhalational anaesthesia vomited one or more times after surgery (difference not significant). The incidence of vomiting was lower in the propofol group during the first 2 h after surgery (0% and 25% propofol and inhalational groups, respectively) (p < 0.05) but was similar at all other time intervals. Rescue anti-emetic was given to two (10%) and eight (40%) children in the propofol and inhalational groups, respectively (p < 0.05). We conclude that propofol anaesthesia alone is not an effective means of preventing vomiting after middle ear surgery in children.     

Tropisetron or ondansetron compared with placebo for prevention of postoperative nausea and vomiting

In a prospective, randomized, double-blind, placebo-controlled, multicentre study, the efficacy of prophylactic tropisetron (2 mg) or ondansetron (4 mg) for the prevention of post-operative nausea and vomiting after abdominal or non-abdominal surgery with general balanced anaesthesia was studied in 842 ASA I-III patients. In patients undergoing abdominal surgery, ondansetron and tropisetron reduced the frequency of emetic episodes compared with the placebo (29%, 30% vs. 42% respectively). In men, neither tropisetron nor ondansetron had an effect different from the placebo, whereas in women both drugs led to lower rates of emetic episodes and nausea. In comparison with abdominal surgery, fewer patients in the non-abdominal surgery subgroup had emetic episodes (42% vs. 23% in the placebo group). However, neither tropisetron nor ondansetron was significantly different from the placebo in this patient subgroup. In conclusion, for patients at increased risk of post-operative nausea and vomiting, a prophylactic therapy at the lowest effective dose with tropisetron or ondansetron may be useful.     

The effect of blockade of the AMPA/kainate receptors of the nucleus accumbens on synaptic dopamine release during an emotional conditioned response

We studied the effect of combining prophylactic ondansetron (4 mg intravenously [IV]) to desflurane-based anesthesia in 90 ASA grade I or 11 women undergoing outpatient gynecological laparoscopy. Recovery after anesthesia, with special focus on postoperative nausea and vomiting (PONV), was assessed. Control groups received a similar desflurane anesthetic (placebo) or a propofol-infusion-based (active control) anesthetic. The study design was randomized, controlled, and double-blind (regarding ondansetron) and single-blind (regarding the anesthetic technique). Early recovery (eye opening, orientation, following commands, sitting) was similar in the three groups. However, overall home readiness (toleration of oral fluids, walking, pain tolerable by oral analgesics, no or only mild nausea) was achieved faster in the desflurane group receiving ondansetron (109 [21-937] min, P < 0.01) and in the propofol group (110 [33-642] min, P < 0.001) when compared to the desflurane only group (372 [45-723] min) (median [range]). The total incidence of PONV in the desflurane-only group was 80% (P < 0.01), compared to 40% and 20% in the desflurane group receiving ondansetron and the propofol group, respectively. The postoperative antiemetic requirements were consistently and significantly (P < 0.01) higher in the desflurane-only group compared to the other two groups. Postoperative sedation, analgesic requirements, and psychomotor recovery (assessed by the Maddox Wing and the Digit Symbol Substitution Tests) were similar in the three groups. Our results suggest that in order to achieve a propofol-like recovery profile in patients with a high likelihood of PONV, desflurane should be combined with a potent antiemetic (e.g., ondansetron).     

Granisetron reduces the incidence of nausea and vomiting after middle ear surgery

We studied the efficacy of granisetron, a selective 5-hydroxytryptamine type-3 receptor antagonist, in preventing postoperative nausea and vomiting (PONV) after middle ear surgery. In a randomized, double-blind, placebo-controlled study, 60 ASA I patients received placebo (saline) or granisetron 40 micrograms kg-1 i.v. immediately before induction of anaesthesia (n = 30 in each group). A standard general anaesthetic technique was used. During the first 24 h after anaesthesia, the incidence of PONV in patients who had received granisetron was lower than in those who had received placebo (17% vs 63%; P < 0.05). There were no clinically important adverse effects in either group. We conclude that granisetron, given before anaesthesia, reduced the incidence of PONV after middle ear surgery.     

Treatment of postoperative nausea and vomiting with single intravenous doses of dolasetron mesylate: a multicenter trial. Dolasetron Mesylate PONV Treatment Study Group

This study was conducted to determine the efficacy and safety of four intravenous (I.V.) doses of dolasetron, an investigational 5-HT3 receptor antagonist, for the treatment of postoperative nausea and/or vomiting (PONV) after outpatient surgery under general anesthesia. This multicenter, randomized, double-blind trial compared the antiemetic efficacy of 12.5, 25, 50, or 100 mg I.V. dolasetron with placebo over 24 h using complete response (no emetic episodes and no rescue medication), time to first emetic episode or rescue medication, and patient nausea and satisfaction with antiemetic therapy as rated by visual analog scale (VAS). Of 1557 patients enrolled, 620 patients were eligible for treatment. Complete response rates for all dolasetron doses--12.5 mg (35%), 25 mg (28%), 50 mg (29%), and 100 mg (29%)--were significantly more effective than placebo (11%, P < 0.05). There was a significant gender interaction for complete response (P < 0.01). Of the patients in the 25-mg and 100-mg dose groups, 12% and 13%, respectively, experienced no nausea (VAS score < 5 mm) versus 5% in the placebo group (P < 0.05). There were no clinically relevant changes in vital signs or laboratory values and no trends with dose for adverse events. Dolasetron is effective for treating PONV and has an adverse event profile similar to that of placebo. The 12.5-mg dose was as effective as larger doses for complete response. IMPLICATIONS: Nausea and vomiting are common problems for postsurgical patients. In this study of 620 patients undergoing surgery, a 12.5-mg dose of intravenous dolasetron, a new serotonin-receptor blocker, was significantly more effective than placebo in treating established postoperative nausea and vomiting. Dolasetron 12.5 mg was as safe as placebo.     

Patients' self-reported functional status after granisetron or ondansetron therapy to prevent chemotherapy-induced nausea and vomiting at six cancer centers

Patient functional status after administration of either granisetron or ondansetron to prevent acute chemotherapy-induced nausea and vomiting (CINV) was studied. Pharmacists and nurses from six cancer centers distributed Functional Living Index-Emesis (FLIE) questionnaires to 115 outpatients receiving either granisetron or ondansetron for prevention of CINV. The emetogenic potential of each patient's chemotherapy regimen was high, moderately high, or moderate. Immediately before and 72 hours after chemotherapy, each patient rated his or her reaction to each of 18 items on the questionnaire on a 7-point scale. Possible scores ranged from 18 to 126, with higher scores indicating higher levels of functioning. The occurrence of nausea in the granisetron group was 40.0% compared with 43.2% in the ondansetron group; the occurrence of vomiting was 18.8% in the granisetron group and 11.1% in the ondansetron group. Patients who received highly emetogenic chemotherapy had significantly lower scores on the FLIE after chemotherapy than before. Patients with both nausea and vomiting reported a much higher negative impact on functional status after chemotherapy than those with nausea only. The mean prechemotherapy and postchemotherapy FLIE scores were 124.2 and 110.4 for granisetron and 124.9 and 111.9 for ondansetron. Granisetron and ondansetron did not differ significantly in their effect on functional status reported by patients before and 72 hours after receiving cancer chemotherapy.     

Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study

BACKGROUND: Intravenous dolasetron mesilate has shown efficacy in the prevention of postoperative nausea and vomiting (PONV) when administered as a single dose prior to emergence from anesthesia. This trial compared intravenous dolasetron and ondansetron for the prevention of PONV when administered at induction of anesthesia. METHODS: This double-blind, placebo-controlled, multicenter trial randomized patients to one of four single IV treatments placebo, 25 or 50 mg dolasetron, or 4 mg ondansetron. Efficacy was measured by complete response (0 emetic episodes and no rescue medication), nausea severity and patient satisfaction as measured on a visual analog scale (VAS), investigator's rating, of nausea severity, and total response (complete response with no nausea [< or = 5 mm VAS]). RESULTS: 514 patients at 24 sites were evaluated for efficacy. The 50 mg dolasetron and 4 mg ondansetron doses were statistically equivalent, and superior to placebo, for all efficacy measures. Complete response rates were 49%, 51%, 71% and 64% for placebo, 25 and 50 mg dolasetron, and ondansetron, respectively. Dolasetron 50 mg was statistically superior to 25 mg dolasetron for complete response, total response, VAS maximum nausea, time to first emetic episode, and patient satisfaction. The majority of adverse events were of mild-to-moderate intensity. Headache was the most frequently reported treatment-related adverse event with a 3%-5% incidence across treatments. CONCLUSION: When given at induction of anesthesia, 50 mg intravenous dolasetron is equivalent to 4 mg ondansetron and superior to 25 mg dolasetron and placebo for the prevention of PONV. All treatments were safely administered and well tolerated.     

A comparison of prophylactic ondansetron and metoclopramide administration in patients undergoing major neurosurgical procedures

In a prospective, randomised, double-blind trial, we assessed the relative efficacy of prophylactic ondansetron and metoclopramide administration in the reduction of postoperative nausea and vomiting in 60 patients undergoing routine major neurosurgical procedures. The patients were randomly allocated into one of two groups. Both groups received a standardised anaesthetic. When the dura mater was closed, patients in group A received an intravenous injection of metoclopramide 10 mg whilst group B received ondansetron 8 mg intravenously. Patients who received metoclopramide experienced less postoperative nausea and vomiting than those who received ondansetron in the 48 h following surgery (17 (56%) versus 9 (30%) p = 0.038). In the light of these findings, we believe that ondansetron is an inappropriate agent for the prevention of postoperative nausea and vomiting in the neurosurgical population.     

Antiemetic prophylaxis after laparoscopic cholecystectomy: comparative study of dehydrobenzperidol, metoclopramide, ondansetron and placebo

OBJECTIVES: To compare the efficacy of ondansetron to that of metoclopramide, dehydrobenzperidol and placebo for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in a double-blind random study. PATIENTS AND METHOD: A total of 100 ASA I, II and III patients undergoing scheduled laparoscopic cholecystectomy were divided into 4 groups according to whether they received one of the following intravenously just prior to anesthetic induction: 1.25 mg dehydrobenzperidol (group D), 10 mg metoclopramide (group M), 4 mg ondansetron (group O) or 2 ml of saline (group P). All received general anesthesia with induction by thiopental, analgesia with fentanyl, muscle relaxation with atracurium and maintenance with oxygen-air and isoflurane. Episodes of nausea and/or vomiting during the first 24 h after surgery were recorded. Treatment was considered effective if no episodes occurred during this period. RESULTS: Nine of the 100 patients were excluded from the study. There were no significant differences in demographic variables among the 4 groups. The incidence of PONV was significantly greater in group P than in any of the other groups. There were no significant differences in PONV among groups D, M and O. CONCLUSIONS: Ondansetron provides safe, effective prophylaxis for PONV after laparoscopic cholecystectomy, but it is not superior to the antiemetic drugs usually used. Its use may be justified in patients in whom dehydrobenzperidol or metoclopramide are contraindicated.     

Results of the Bruce treadmill test in children after arterial switch operation for simple transposition of the great arteries

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P < 0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for "rescue" analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.     

A comparison of prophylactic ondansetron hydrochloride and droperidol for strabismus repair in adults

BACKGROUND: Prophylactic administration of an antiemetic is a common procedure for patients undergoing strabismus surgery. Droperidol and ondansetron hydrochloride are commonly used antiemetics. This study compared the rates of postoperative nausea and vomiting (PONV) in adult patients undergoing strabismus surgery with prophylactically administered Droperidol or ondansetron hydrochloride. METHODS: A double-masked, randomized, prospective study was conducted comparing droperidol with ondansetron hydrochloride when administered prophylactically to adults undergoing strabismus surgery. RESULTS: Forty-five patients entered the study with a mean age of 30 years. Twenty percent of patients had nausea immediately postoperatively and 37% had nausea before discharge with no significant differences between groups. Overall rate of emesis, time in the recovery room, and time to discharge was not significantly different between the droperidol and ondansetron hydrochloride group. CONCLUSION: No real differences in the ability to prevent PONV between the two medications were found in this study.     

Efficacy of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting after total hip replacement or total knee replacement procedures: a randomized, double-blind, comparative trial

BACKGROUND: Limited data are available on the efficacy of ondansetron hydrochloride compared with prochlorperazine maleate for the treatment of postoperative nausea and vomiting (PONV). OBJECTIVE: To evaluate the comparative efficacy of ondansetron and prochlorperazine for the prophylaxis of PONV in patients undergoing total hip replacement or total knee replacement procedures. METHODS: A randomized, double-blind, comparative trial was conducted at a tertiary care, university hospital. Seventy-eight patients undergoing elective total hip or total knee replacement procedures received a single dose of ondansetron hydrochloride (n = 37), 4 mg intravenously, or prochlorperazine maleate (n = 41), 10 mg intramuscularly, at the end of the surgical procedure. Rescue therapy was administered every 4 hours as needed during the initial 48 hours. Primary outcome measures were the incidences and severity of PONV. Secondary outcome measures included the number of rescue antiemetic doses required, number of physical therapy cancellations because of PONV, length of hospital stay, and cost of antiemetic agents administered. RESULTS: The incidence of nausea was significantly greater in the ondansetron group compared with the prochlorperazine group (81% vs 56%; odds ratio, 3.4; 95% confidence interval, 1.2-9.4) as was the severity of nausea (P = .04). Multivariate analysis identified administration of ondansetron, history of PONV, obesity, and female sex as risk factors for a nausea event. The incidence of vomiting tended to be greater in the ondansetron group (49% vs 32%; odds ratio, 2.0; 95% confidence interval, 0.8-5.0). The need for rescue antiemetic therapy was also greater in the ondansetron group (46% vs 27%; odds ratio, 2.3; 95% confidence interval, 0.9-6.0). The mean antiemetic drug cost per patient was significantly greater for the ondansetron group ($47.56 vs $2.47; P<.001). However, the proportion of patients who were unable to participate in physical therapy because of PONV and the median length of hospital stay were similar in both groups. CONCLUSION: Prochlorperazine is associated with superior efficacy and significant cost savings compared with ondansetron for the prevention of PONV in patients undergoing total hip and total knee replacement procedures.     

Ultrasound biomicroscopic imaging in intermediate uveitis

The clinical benefit of propofol anaesthesia in the prevention of postoperative nausea and vomiting (PONV) is still being elucidated despite many studies to date. In this study 64 adult female patients scheduled for thyroidectomy received, in a randomized double-blind fashion, propofol with air or isoflurane with nitrous oxide for maintenance of anaesthesia. The primary response variable was the presence or absence of vomiting in the first six hours. A group sequential design was used to allow interim analysis. After 64 patients, the fourth analysis showed that fewer patients receiving propofol vomited or required an anti-emetic during the first six hours (P < 0.05). There was no significant difference detected in the 6 to 24 hour interval. In this group of female patients, total intravenous anaesthesia (TIVA) with propofol is associated with an early reduction in early postoperative vomiting compared with standard inhalational techniques. This reduction in vomiting does not appear to persist beyond the first six hours.