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Comparison of Ondansetron with Ondansetron and Dexamethasone in prevention of postoperative nausea vomiting in abdominal surgery  [cached]
Abbas ali Ajani,Amol Prakash Singam,ashok Chaudhari,aruna vijay chandak
International Journal of Biomedical and Advance Research , 2013, DOI: 10.7439/ijbar.v4i1.873
Abstract: Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV). Methods: This double blind, randomized, prospective, Placebo controlled study was carried out in 120 patients, aged 20-60 yr, ASA-I and II physical status posted for exploratory laparotomy for various clinical conditions under general anaesthesia The patients were divided into three groups of 40 each. Patients received one of the three regimes for prevention of PONV before induction. Group P : Received 4 ml Normal saline I.V, Group O : Received injection Ondansetron 4mg (2 ml) + 2 ml Normal Saline. Group OD : Received injection Ondansetron 4 mg (2 ml) and injection Dexamethasone 8mg( 2 ml). Nausea and vomiting were looked from 0 min upto 24 hours. Retching and vomiting were grouped together under common term ' emetic episodes '. Results: Though ondansetron was effective in controlling postoperative nausea, the ondansetron plus dexamethasone combination was more effective overall. Though ondansetron was effective in reducing postoperative emetic episodes, the combination of ondansetron plus dexamethasone was more effective.The requirement for rescue antiemetic was less in ondansetron group and least in ondansetron plus dexamethasone group. There was no significant difference between pain intensity and sedation between these groups at any time. Only adverse effect reported was headache in ondansetron and ondansetron plus dexamethasone groups. Conclusion: Ondansetron plus dexamethasone combination is more effective in reducing incidence of PONV without causing any major side effects. Throughout the study, ondansetron plus dexamethasone combination was superior to ondansetron alone in all respects pointing towards the potentiating effect of dexamethasone. Keywords : PONV, Ondansetron, Dexamethasone, General Anesthesia.
Intravenous Ondansetron as Antiemetic Prophylaxis for Postoperative Nausea and Vomiting after Shoulder Arthroscopy  [PDF]
Yi-Fan Chen,Wen-Lin Yeh,Ko-Hong Lee,Ming-Chieh Li
Chang Gung Medical Journal , 2011,
Abstract: Background: Nausea and vomiting are common chief postoperative complaints. The clinicalliterature indicates that postoperative nausea and vomiting (PONV) iscommon after orthopedic surgery. This study examines the clinical therapeuticefficacy of Ondansetron injected intravenously before the end of shoulderarthroscopy as antiemetic prophylaxis to help reduce the incidence of PONV.Methods: Participants were identified through retrospective chart review and patientsundergoing shoulder arthroscopy performed by the same orthopedic surgeonat the same hospital from 2005 to 2009 were analyzed. Subjects were classifiedinto two groups based on whether Ondansetron was given. Differencesin the incidence of PONV among the two groups were compared. Basicpatient information, anesthesia records, and surgical records were obtained,as well as records on PONV, postoperative pain intensity, and postoperativeanalgesic injections within 24 hours after surgery.Results: The study involved 90 patients. The Group A contained 34 patients who didnot receive Ondansetron, and the Group B contained 56 patients who weregiven Ondansetron. Analytical results for the postoperative 24 hour periodshowed a significant difference in the incidence of vomiting between the twogroups, with a lower incidence (p < 0.05) for the. Group B. However therewas no significant difference in the incidence of nausea between the twogroups in the same postoperative 24 hour period, although there was a trendof a lower incidence in the Group B (p = 0.17). The overall incidence ofPONV during the 24-hour period was lower in the Group B (14%) than theGroup A (32%), and the Group B demonstrated lower pain intensity andlower analgesic injection needs.Conclusion: Routine intravenous injection of Ondansetron 30 minutes before completionof shoulder arthroscopy can reduce the incidence of vomiting and overallPONV in patients. Additionally, the patients using Ondansetron demonstratedlower pain intensity and lower analgesic injection needs than the controlgroup.
Preemptive Treatment of Nausea and Vomiting of Pregnancy: Results of a Randomized Controlled Trial  [PDF]
Caroline Maltepe,Gideon Koren
Obstetrics and Gynecology International , 2013, DOI: 10.1155/2013/809787
Abstract: Objectives. To determine whether the initiation of treatment (preemptive treatment) before the symptoms of nausea and vomiting of pregnancy (NVP) versus when the symptoms begin can improve the outcome in patients at a high risk for recurrence of severe NVP. Study Design. Prospective, randomized controlled trial. Results. Preemptive therapy conferred a significant reduction in HG as compared to the previous pregnancy ( . In the preemptive arm, there were 2.5-fold fewer cases of moderate-severe cases of NVP than those in the control group (15.4% versus 39.13%) in the first 3 weeks of NVP ( . In the preemptive group, significantly more women had their NVP resolved before giving birth (78.2% versus 50%) ( . Conclusions. Preemptive treatment with antiemetics is superior to the treatment that starts only when the symptoms have already occurred in decreasing the risk of severe forms of NVP. 1. Introduction Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, affecting 50–90% of pregnant women [1]. Its extreme form, hyperemesis gravidarum (HG) occurs in 0.5–3% of pregnancies leading to dehydration, electrolyte imbalance, and hospitalization. The severe forms of NVP tend to recur in up to 80% in the same women, leading to anxiety about starting another pregnancy [1]. Severe NVP has been associated with women’s request to terminate otherwise—wanted pregnancies due to symptom severity [1–5]. Nausea, vomiting, and retching associated with NVP are typically treated with different classes of antiemetics [2]. The delayed release combination of 10?mg doxylamine and 10?mg pyridoxine (Diclectin, Duchesnay, Inc.) is labeled in Canada specifically for NVP and has been used by large numbers of Canadian women [1–4, 6]. In an attempt to improve the management of NVP, in 1995 the Motherisk Program at the Hospital for Sick Children in Toronto, Ontario, initiated an NVP Counseling Helpline and developed evidence-based guidelines to optimize fluid and caloric intake, while minimizing stimuli of nausea and vomiting. In 2004 we hypothesized that the preemptive use of antiemetics in women who had experienced severe NVP in the previous pregnancy may mitigate the severe symptomatology [7] in a manner similar to other conditions, such as chemotherapy-induced nausea and vomiting, motion sickness, or cyclic vomiting [8–10]. We are not aware of any other published intervention study on the preemptive effects of antiemetic modalities on the course and severity of NVP. In 1992 Czeizel and colleagues described improvement in the first-trimester nausea and
Effect of ondansetron alone and in combination with domperidone in the prevention of chemotherapy-induced nausea and vomiting in breast cancer patients
Kaberi Das Gupta, A.K.M. Mosharrof Hossain, Saad Uddin Jaigirdar, Borhan Uddin, Tridiv Choudhury and Dipti Rani Saha
Bangladesh Journal of Pharmacology , 2007,
Abstract: The efficacy and safety of ondansetron, administered alone and in combination with domperidone to prevent chemotherapy-induced nausea and vomiting of breast cancer patients receiving chemotherapy FAC regimen (5-fluorouracil, adriamycin and cyclophosphamide) were evaluated. A consecutive open-label interventional study was conducted on a total number of 86 female breast cancer patients who were receiving chemotherapy. Forty two patients received ondansetron (8 mg) intravenously 30 min before chemotherapy which is followed by ondansetron (8 mg) administered orally every 8 hourly for 2 days from the day of start of chemotherapy. Another 44 patients received ondansetron (8 mg) intravenously 30 min before chemotherapy followed by ondansetron (8 mg) plus domperidone (20 mg) administered orally 8 hourly for 48 hours from the day of start of chemotherapy. The number of emetic episodes, severity of nausea, assessment of appetite and adverse events were recorded at 8 hour intervals for two days study period using specific scoring criteria. Ondansetron in combination with domperidone significantly decreased the chemotherapy-induced nausea and vomiting in comparison with ondansetron administered alone (P< 0.001). Appetite status was good with combination therapy (P<0.001). Improvement in appetite indicates that ondansetron plus domperidone exert protective effect against nausea and maintain normal appetite, while patients who were getting monotherapy experience loss of appetite. The common adverse event, headache was present in both the groups. No extrapyramidal reaction was observed in any group. This study showed that ondansetron plus domperidone exert more pronounced antiemetic effect in patients with breast cancer receiving moderately emetogenic chemotherapy (FAC regimen) with good appetite status and less adverse effect.
PATIENT POSITION AS A POSSIBLE RISK FACTOR FOR POSTOPERATIVE NAUSEA AND VOMITING (PONV) IN GYNECOLOGIC LAPAROSCOPY
Aleksandar ?iri?,Velimir Coli?,Sava Ran?i?,Du?ko Madzi?
Acta Medica Medianae , 2012,
Abstract: Postoperative nausea and vomiting (PONV) are still a significant problem in modern anesthetic practice. Discomfort caused by PONV intensifies other unpleasant elements of recovery, such as pain, frustration or fear. PONV also generates aversion to future anesthesia and have a negative impact on staff and patient's family. PONV can increase the cost of completing a surgical procedure, because it extends the time a patient spends in the postanesthesia care unit (PACU) or delay discharge of ambulatory patients. It is generally accepted that the incidence of PONV after general anesthesia for various types of surgery in the last decade is still between 20-30%, and 70% in laparoscopic abdominal surgery. The incidence is three times higher in females compared to males. Many factors are involved in triggering PONV, such as patientrelated factors, the type of surgery, anesthesia management, etc. The results of this study suggest that the patient positioning (modified supine lithotomy position with ''Trendelenburg") increases the risk of PONV in gynecologic laparoscopy.
Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy  [PDF]
B Gautam,BR Shrestha,P Lama,S Rai
Kathmandu University Medical Journal , 2008, DOI: 10.3126/kumj.v6i3.1706
Abstract: Background: Postoperative nausea and vomiting (PONV) is a common distressing experience in patients following laparoscopic surgeries. This study was aimed at comparing the efficacies of Ondansetron-Dexamethasone combination with each drug alone as a prophylaxis against PONV in patients after elective laparoscopic cholecystectomy done under general anaesthesia. Materials and methods: Hundred and fifty ASA I and II patients, aged 23 to 65 yrs, were enrolled in this prospective, randomized, double-blind trial to receive one of three treatment regimens: 4 mg Ondansetron (Group O), 8 mg Dexamethasone (Group D) or 4 mg Ondansetron plus 8 mg Dexamethasone (Group OD) (n=50 for each). A standardized balanced general anaesthetic technique was employed. Any episode of PONV and need for rescue antiemetic were assessed at six, 12 and 24 hrs post operation. Complete response was defined as no PONV in 24 hrs and need for rescue antiemetic was considered as failure of prophylaxis. Pain scores, time to first analgesia demand, amount of Meperidine consumption, adverse event(s) and duration of hospital stay were recorded. Results: Complete response occurred in 66.7, 66.0 and 89.4% in Groups O, D and OD respectively. Rescue antiemetics were required in 29.2, 31.9 and 8.5% of patients in Groups O, D, and OD respectively. Significantly high incidence of vomiting and failure of prophylaxis (19.1%) occurred in group D during the first six hrs (P=0.023 versus O & 0.008 versus OD). More frequent antiemetic rescue was required in group O at 6 to 24 hr interval as compared to group OD (P=0.032). Conclusion: Combination of Ondansetron and Dexamethasone is better than each drug alone in preventing PONV after laparoscopic cholecystectomy. Dexamethasone alone is significantly less effective in preventing early vomiting compared to its combination with Ondansetron; whereas Ondansetron alone is less effective against late PONV as compared with combination therapy. Key words: Antiemetic prophylaxis; Dexamethasone; laparoscopic cholecystectomy; Ondansetron; postoperative nausea and vomiting (PONV) doi: 10.3126/kumj.v6i3.1706 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 319-328
A Comparison of Preoperative Ondansetron and Dexamethasone in the Prevention of Post-Tympanoplasty Nausea and Vomiting
Mahmoud Eidi,Khosro Kolahdouzan,Hamzeh Hosseinzadeh,Razieh Tabaqi
Iranian Journal of Medical Sciences , 2012,
Abstract: Background: Nausea and vomiting are common complications of anesthesia and surgery. Patients undergoing tympanoplasty are exposed to a higher risk of postoperative nausea vomiting (PONV). These complications may alter the results of reconstruction and anatomical alignments. Numerous antiemetics have been studied to prevent and treat PONV in patients undergoing tympanoplasty. The aim of this study was to compare the effect of intravenous ondansetron and dexamethasone on post-tympanoplasty PONV.Methods: In a double-blind randomized controlled clinical trial, 219 patients were divided into three groups including one receiving ondansetron, one receiving dexamethazone, and one receiving distilled water. All patients were subjected to tympanoplasty type I. The patients in the first group received ondansetron (4 mg IV), second group received oexamethasone (8 mg IV), and third group received distilled water prior to induction of anesthesia. Using Bellivelle’s scoring system, the incidence of PONV and its severity during the 24-hour period after surgery were measured and compared.Results: There was no significant difference among PONV in the three groups in the first two hours after the surgery. However, in 2-8, 8-16 and 16-24 hours after the surgery the PONV in ondansetron and dexamethasone groups were significantly lower than that in the control group. Conclusion: Ondansetron and dexamethasone were more effective than placebo in controlling PONV after tympanoplasty surgeries. Moreover, dexamethasone was more effective than ondansetron in preventing PONV.Trial Registration Number: IRCT201106154005N4
Comparing the Efficacy of Prophylactic P6 Acupressure, Ondansetron, Metoclopramide and Placebo in the Prevention of Vomiting and Nausea after Strabismus Surgery
Ali Reza Ebrahim Soltani,Hossein Mohammadinasab,Mehrdad Goudarzi,Shahriar Arbabi
Acta Medica Iranica , 2011,
Abstract: To compare the efficacy of acupressure wrist bands, ondansetron, metoclopramide and placebo in the prevention of vomiting and nausea after strabismus surgery. Two hundred patients, ASA physical status I or II, aged between 10 and 60 years, undergoing strabismus surgery in Farabi Hospital in 2007-2008 years, were included in this randomized, prospective, double-blind and placebo-controlled study. Group I was the Control, group II received metoclopramide 0.2 mg/kg, group III received ondansetron 0.15 mg/kg iv just before induction, in Group IV acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I, II and III. The acupressure wrist bands were applied 30 min prior to the induction of anesthesia and removed six hours after surgery. Postoperative nausea and vomiting (PONV) was evaluated within 0-2 hours and 2-24 hours after surgery by a blinded observer. Results were analyzed by X2 test. A P value of < 0.05 was taken as significant. The incidence of PONV was not significantly different in acupressure, metoclopramide and ondansetron during the 24 hours. Acupressure at P6 causes a significant reduction in the incidence of PONV 24 hours after strabismus surgery as well as metoclopramide 0.2 mg/kg and ondansetron 0.15 mg/kg iv for patients aged 10 or more.
Prophylaxis of Postoperative Nausea and Vomiting in Adolescent Patients: A Review with Emphasis on Combination of Fixed-Dose Ondansetron and Transdermal Scopolamine  [PDF]
Joseph V. Pergolizzi,Robert Raffa,Robert Taylor
Journal of Drug Delivery , 2011, DOI: 10.1155/2011/426813
Abstract: Postoperative nausea and vomiting (PONV) is a relatively common occurrence (20–30%) that delays discharge and, if persistent, can lead to serious complications. The incidence of PONV is a function of patient characteristics, the type and duration of surgery, the type of anesthesia, and the choice of pre-, intra-, and postoperative pharmacotherapy. There are no completely effective antiemetic agents for this condition, but recommendations for treatment strategies are separately available for pediatric and adult patients. Left unclear is whether adolescents should be guided by the pediatric or the adult recommendations. We review the developmental physiology of the relevant physiological factors (absorption, distribution, metabolism, and elimination). We also review the clinical evidence regarding the safety and efficacy of a fixed-dose combination of ondansetron (4 mg, i.v.) and transdermal scopolamine (1.5 mg).
A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia  [PDF]
Chang Yen Yin, José Reinaldo Cerqueira Braz, Wei Tzon Hackan Chang Colares, Lídia Raquel de Carvalho, Marília Pinheiro Módolo, Paulo do Nascimento Junior, Norma Sueli Pinheiro Módolo
Open Journal of Anesthesiology (OJAnes) , 2017, DOI: 10.4236/ojanes.2017.78026
Abstract: Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed; Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia; and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-morphine spinal anesthesia.
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