Comparison of Ondansetron and Metoclopramide in the Prevention of Nausea and Vomiting after Laparoscopic Cholecystectomy Under General Anaesthesia

Abstract

Objective: To evaluate and compare the antiemetic efficiency of ondansetron with metoclopramide when 
administered prophylactically for the prevention of post operative nausea and  vomiting after laparoscopic 
cholecystectomy.   
Study Design: Prospective, Randomised, Comparative study. 
Place and duration of study: The study was conducted at the department of Anaesthesia Fauji Foundation 
Hospital, Rawalpindi from Sep 2010 to may 2011.  
Patients and Methods: Total 90 ASA grade-I and ASA grade-II patients, sex female, and age 35 – 70 years 
undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomly divided into 
three groups, 30 in each group. Group-I received 4 mg intravenous ondansetron, group-II received 10 mg, 
Intravenous metoclopramide and group-III received intravenous 0.9% normal saline 2 minutes prior to induction of 
anaesthesia. They received standard General Anaesthesia for surgery. Post operative analgesia was provided with 
intravenous ketorelac 30 mg. There was no difference among the groups in patient charactertics and risk factors for 
PONV. Patients were observed for 24 hours after operation for occurrence of nausea and vomiting and requirement 
of rescue antiemetic. Efficiency of the drug was evaluated as (a) complete response- no nausea and no vomiting. (b) 
Mild response –  Nausea with no vomiting (c) Moderate response – 1-2 vomiting episodes / moderate nausea (d) 
Severe response - > 3 vomiting episodes /severe nausea.  
Results: During 1st 24 hours after operation incidence of nausea and vomiting was 77% in patients in placebo 
group, was 33% in patients in the ondansetron group and 53% in patients in the metoclopramide group. The 
incidence of PONV was significantly lower in patients who received ondansetron (P < 0.05) as compared to 
metoclopramide or placebo.  Complete response with no nausea and vomiting was higher in patients who received 
ondansetron (66 %) than in patients who received metoclopramide (46 %) or placebo (23 %). The incidence of 
nausea with vomiting (moderate to severe response) was significantly lower with ondansetron (20 %) as compared 
to metoclopramide (34 %) and placebo (60 %). There was no need for another  rescue antiemetic in (80 %) patients, 
with ondansetron (67%) with metoclopramide, (40 %) with placebo. 
Conclusion: Single intravenous dose of 4 mg ondansetron when administered prophylactically is more effective 
than 10 mg intravenous metoclopramide in the prevention of PONV after laparoscopic cholecystectomy. Single 4 
mg IV dose of ondansetron reduces the incidence and severity of PONV and also requirement of rescue antiemetic 
in the Post operative period.