Prevention of postoperative nausea and vomiting after laparoscopic gynaecological surgery. Combined antiemetic treatment with tropisetron and metoclopramide vs. metoclopramide alone

BACKGROUND AND OBJECTIVE: Female patients undergoing gynaecological procedures, especially laparoscopically, are at high risk of postoperative nausea and vomiting. No available antiemetic is entirely effective. This double-blinded randomized trial examines the efficacy and safety of tropisetron and metoclopramide in combination and compares the results with metoclopramide alone in laparoscopic gynaecological surgery. METHODS: One hundred and twenty female patients scheduled for minor gynaecological laparoscopy, aged 27-43 years, were randomly allocated to receive pretreatment with metoclopramide 10 mg intravenously (n=57) or tropisetron 5 mg with metoclopramide 5 mg (n=63). RESULTS: Fewer patients in the combined treatment group experienced postoperative nausea and vomiting (14% vs. 37%, P=0.008) or needed rescue antiemetic treatment (3% vs. 16%, P=0.038). No significant adverse events were observed. CONCLUSIONS: The combination of the antiemetics was superior, which is probably explained by the fact that the two drugs have different sites of action, thus preventing emesis by blocking different pathways.