A comparative study of ondansetron and granisetron in combination with dexamethasone-in prophylaxis for postoperative nausea and vomiting (PONV) in laproscopic cholecystectomies

Authors

  • Nethra H. Nanjundaswamy Department of Anaesthesiology, Bangalore Medical College and Research Institute, Banglaore, Karnataka, India
  • Raghavendra Biligiri Sridhara Department of Anaesthesiology, Bangalore Medical College and Research Institute, Banglaore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20180288

Keywords:

Cholecystectomy, Dexamethasone, Granisetron, Laparoscopy, Ondansetron, PONV

Abstract

Background: Post operative nausea and vomiting (PONV) is a common problem and distressing symptom in surgical patient population. General anaesthesia with inhalational agents is associated with an average PONV incidence of 20-30 % in surgical patients. PONV is difficult to treat and needs multiple drugs and combination of drugs. Granisetron and Ondansetron are among the commonly used 5HT3 antagonists and used in combination with dexamethasone for prophylaxis against PONV. The aim of the study was to compare the efficacy of combination of antiemetics-Ondansetron 4mg+Dexamethasone 8mg and Granisetron 1mg+Dexamethasone 8mg in prevention of post operative nausea and vomiting.

Methods: 75 patients of ASA 1 and 2 were randomly allocated to three groups-Group 1 (n=25) received Ondansetron 4mg+Dexamethasone 8mg; Group 2 (n=25)-received Granisetron 1mg+Dexamethasone 8mg; Group 3-received saline with dexamethasone 8mg. Standard general anaesthesia protocol was followed. Study drugs were administered at the time of induction. Post operative nausea and vomiting was studied for period of 24hrs. Severity was assessed using PONV Score (0=no nausea;1=nausea only;2=retching;3=vomiting). The adverse effects were also studied.

Results: The incidence of PONV was 16% in Group 1 and 2 and 68% in Group 3. The complete response after 24hr period was 32% in control group, 84% in Group 1 and Group 2. Rescue antiemetics were required only in control group. There was no statistical difference noted between Group 1 and Group 2 but there was clinical and statistical significance noted between groups which received prophylactic antiemetic combination and control. Adverse effects were not observed in any group.

Conclusions: Granisetron 1mg and Ondansetron 4mg in combination with dexamethasone 8mg are equally effective and safe in decreasing the incidence of post operative nausea and vomiting in laproscopic cholecystectomies under general anaesthesia.

References

Gan TJ. Risk Factors for Postoperative Nausea and Vomiting. Anesth Analg. 2006;102:1884-98.

Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, et al. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesthesia Analgesia. 2007;105(6):1615-28.

Elhakim M, Nafie M, Mahmoud K, Atef A. Dexamethasone 8mg in combination with ondansetron 4mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Canadian J Anesthesia. 2002;49(9):922-6.

Watcha MF, White PF. Postoperative nausea and vomiting: Its etiology, treatment and prevention. Anesthesiology. 1992;77:162-82.

Sriraman R, Indu S, Chari P. Is granisetron-dexamethasone combination better than ondansetron-dexamethasone in the prevention of postoperative nausea and vomiting in outpatient gynaecological laparoscopy. J Anaesthesiol Clin Pharmacol. 2007;23(4):365.

Kushwaha B, Chakraborty A, Agarwal J, Malick A, Bhushan S, Bhattacharya P. Comparative study of granisetron and ondansetron alone and their combination with dexamethasone, for prevention of PONV in middle ear surgery. Inter J Anesthesiol. 2007;13(2):10.

Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesthesia Analgesia. 2003;97(1):62-71.

Gan TJ, Coop A, Philip BK, Kytril Study Group. A randomized, double-blind study of granisetron plus dexamethasone versus ondansetron plus dexamethasone to prevent postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Anesthesi Analgesia. 2005;101(5):1323-9.

Fujii Y, Tanaka H, Toyooka H. Granisetron-dexamethasone combination reduces postoperative nausea and vomiting. Canadian J Anesthesia/J canadien d'anesthésie. 1995;42(5):387-90.

Gan TJ. Selective serotonin 5-HT3 receptor antagonists for postoperative nausea and vomiting. CNS drugs. 2005;19(3):225-38.

Si XY, Wu LP, Li XD, Li B, Zhou YM. Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy. Asian journal of surgery. 2015;38(1):21-7.

Fujii Y, Tanaka H, Toyooka H. Optimal Anti-Emetic dose of granisetron for prevention of post operative nausea and vomiting. Can J Anaesth. 1994;41(9):794-7.

Dabbous AS, Jabbour-Khoury SI, Nasr VG, Moussa AA, Zbeidy RA, Khouzam NE, et al. Dexamethasone with either granisetron or ondansetron for postoperative nausea and vomiting in laparoscopic surgery. Middle East J Anesthesiol. 2010;20(4):565-70.

Gan TJ, Coop A, Philip BK, Kytril Study Group. A randomized, double-blind study of granisetron plus dexamethasone versus ondansetron plus dexamethasone to prevent postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Anesthesia Analgesia. 2005;101(5):1323-9.

Sanjowal L, Biswas SK, Saha JC. Comparison of Ondansetron Used Alone and in Combination with Dexamethasone as a Prophylaxis for Postoperative Nausea and Vomiting Following Laparoscopic Cholecystectomy. Faridpur Med Coll J. 2014;9(1):3-6.

Ahsan K, Abbas N, Naqvi SM, Murtaza G, Tariq S. Comparison of efficacy of ondansetron and dexamethasone combination and ondansetron alone in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. J Pak Med Assoc. 2014;64(3):242-6.

De Oliveira Jr GS, Castro-Alves LJ, Ahmad S, Kendall MC, Mccarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesthesia & Analgesia. 2013;116(1):58-74.

Zhu M, Zhou C, Huang B, Ruan L, Liang R. Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surger y: A meta-analysis. J Inter Med Res. 2017;45(3):904-11.

Thomas R, Jones N. Prospective, randomized, double blind comparative study of dexamethasone, ondansetron and ondansetron plus dexamethasone as prophylactic anti-emetic therapy in patients undergoing day case gynecological surgery. British J Anaes. 2001;87(4):588-92.

Downloads

Published

2018-01-24

How to Cite

Nanjundaswamy, N. H., & Sridhara, R. B. (2018). A comparative study of ondansetron and granisetron in combination with dexamethasone-in prophylaxis for postoperative nausea and vomiting (PONV) in laproscopic cholecystectomies. International Journal of Research in Medical Sciences, 6(2), 503–508. https://doi.org/10.18203/2320-6012.ijrms20180288

Issue

Section

Original Research Articles