Comparison of Ondansetron and Metoclopramide for PONV Prophylaxis in Laparoscopic Cholecystectomy

Background: Postoperative nausea and vomiting (PONV) are common distressing complications of surgery and anaesthesia. Objective: The present study was designed to compare the relative antiemetic efficacy and safety of intravenous (I/V) ondansetron and metoclopramide for prevention of PONV after elective laparoscopic cholecystectomy in adult female patients under General Anesthesia (GA). Material and methods: In this prospective, randomized, placebo-controlled, double-blind study we included 150 adult American Society of Anesthesiologists (ASA) Grade I or II female patients, aged 18-55 years, undergoing elective laparoscopic cholecystectomy under GA. The anaesthetic technique, drugs, monitoring and care were standardized in all the patients during the perioperative period. The patients were divided into two groups using random numbers table. Group A (n=50) received ondansetron 4 mg/2ml while group B (n=50) received metoclopramide 10 mg/2 ml I/V just before induction of anaesthesia. Patients were observed for the initial 24 hours after anesthesia. The presence or absence of nausea and vomiting (by simply yes or no) was assessed by a resident anesthetist double blind to the study The rescue antiemetic (cyclizine 10 mg) I/V, was given, if patient suffered from nausea for more than 15 minutes, or experience retching or vomiting during study period. Results: In comparison to metoclopramide group, the frequency of nausea and vomiting was clinically and statistically lower in ordansetron group (p=0.035). Use of rescue antiemetic was significantly higher in metoclopramide group (p=0.022). Conclusion: Our study showed that prophylactic use of ondansetron is more effective with fewer side effects than metoclopramide in the prevention of PONV during laparoscopic cholecystectomy in adult females. Furthermore, metoclopramide was associated with more adverse effects, major being dizziness and extrapyramidal symptoms.