Page 33 - World Journal of Laparoscopic Surgery

Comparison of Drugs and Intravenous Crystalloid in Reduction of Postoperative Nausea and Vomiting after Lap Surgery

TABLE 3: Postoperative nausea and vomiting
Comparison of drug 1st versus drug 2nd
Ondansetron versus Ondansetron versus Droperiodol versus
metoclopramide droperiodol metoclopramide
Nausea 10 13 15
No of studies 907/1697 (53) 1587/2743 (58) 473/1021 (46)
Nausea/no of patients (%)
Incidence nausea (5)
Drug 1 48 57 41
Drug 2 59 58 52
Pooled OR (95% CI) 0.70 (0.45, 1.10) 0.99 (0.66, 1.47) 0.66 (0.48, 0.90)
P 0.125 > 0.9 0.008
Vomiting
No of studies 17 22 20
Vomiting/no. of patients (%) 955/2272 (42) 1435/3750 (38) 412/1374 (30)
Incidence vomiting (%)
Drug 1 35 34 26
Drug 2 50 42 34
Pooled OR (95% CI) 0.43 (0.31, 0.61) 0.70 (0.52, 0.94) 0.68 (0.54, 0.85)
P < 0.001 0.018 < 0.001

OR = odds ratio, *Drugs 1—the first drug in each comparison, Drug 2—the second drug in each comparison.

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versus droperidol (Table 3) and the difference between them
in 1st day (Fig. 1).
This prospective, randomized, double-blind clinical
investigation has shown a beneficial effect of rapid infusion of
30 ml kg–1 compared with 10 ml kg–1 of crystalloid solution in
reducing the incidence of PONV after gynecologic laparoscopy
in ASA 1 female patients. However, there were no significant
differences in the subjective symptoms of dizziness, thirst or
opioid consumption at any time. Sore throat was transiently
increased in the CSL-30 group on emergence from anesthesia
(Table 4).

Fig. 1: Distribution for nausea and vomiting postoperatively in 1st
24 h light bars = ondesteron, dark bars = droperidol, p = 0.115 for the
TABLE 4: Subject characteristics comparisons in the study for the patient receiving crystalloid fluid. In
the first 48 h after anesthesia, the incidence of vomiting was lower in
Ondansetron Droperidol the CSL-30 group than in the CSL-10 group (8.6% vs 25.7%, P =
(n = 80) (n = 78)
0.01). Antiemetic use was less in the CSL-30 group at 0.5 h (2.9% vs
Age (yr) 33 (18-49) 32 (19-50) 14.3%, P = 0.04). The incidence of severe nausea was significantly
Weight (kg) 70 (43-128) 68 (46-110) reduced in the treatment group at awakening (2.9% vs 15.7%, P =
Operative time (min) 25 (7-75) 28 (5-106) 0.02), 2 h (0.0% vs 8.6%, P = 0.04) and cumulatively (5.7% vs 27.1%,
Anesthesia time (min) 52 (28-105) 53 (28-152) P = 0.001) 12
Type of surgery
Tubal ligation 52 56 The result for dexamethasone in comparison with
Diagnostic lap 17 12 metaclopramide as in Tables 5 to 7. Patients in group I reported
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Pelviscopy 11 10
Time in PACU (min) 128 (75-268) 118 (42-220) a lower incidence of PONV and requested less rescue antiemetics
Fentanyl dose (μg) 206 (0-550) 178 (0-575) than those in group III during the first four postoperative hours
(P < 0.01). Patients in group I reported a lower incidence of
Values are mean (range). There were no significant differences between
groups. PONV than those in groups II (P < 0.05) and III (P < 0.01) during
Lap = Laparoscopy, PACU = postanesthesia care unit. the 24 hr postoperative period. Groups II and III did not differ

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