Page 43 - World Journal of Laparoscopic Surgery

Reduction of Vomiting after Laparoscopic Cholecystectomy
between the groups in terms of severity of nausea and vomiting in
24 hours. According to the calculated mean for nausea and vomiting
severity in the groups, it is concluded that the highest severity of
nausea and vomiting has occurred in the ondansetron group and
the lowest in the group receiving the aprepitant plus ondansetron.
On the other hand, according to Pearson’s correlation test,
there was no significant difference between age and nausea and
vomiting.

dIscussIon
Nausea and vomiting are common complications in the
postoperative period, which causes bad and unpleasant feelings
and delays in discharge of patients. Nausea and vomiting may
lead to serious but rare complications, such as aspiration and
postoperative hypoxemia, fluid and electrolyte imbalance, and
the dehiscence of the surgical site. Postoperative nausea and
vomiting in 20–30% of patients and are the second most common
Fig. 2: Means plot of nausea and vomiting at 6 hours in groups postoperative complication. Some factors, such as age, sex, previous
history of nausea and vomiting, motion sickness, type of surgery,
duration of anesthesia and surgery, and anxiety of the patient and
parents are among the factors influencing nausea and vomiting that
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are not under the control of anesthesiologist. Several methods
and drugs, including metoclopramide, droperidol, a specific HT-5
antagonist, propofol, and dexamethasone, are used to treat this
condition. The most commonly used drug is metoclopramide,
which has the potential for extreme opiates and side effects, such
as drowsiness, dizziness and headache, and low effect duration.
Research in reducing postoperative nausea and vomiting focuses on
effective low-dose medications and therapies. Medication should
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have the greatest effect and least complication. This study aimed
to compare the effects of aprepitant and ondansetron separately
and their combination on postoperative nausea and vomiting
after laparoscopic cholecystectomy. The mean age of patients in
the study was 39.14 ± 7.78 years, which was 42.17 ± 14.03 in similar
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studies. The patients were conformed in different age groups,
which were similar in parallel studies. 14,15
Comparisons between groups were performed using statistical
Fig. 3: Means plot of nausea and vomiting at 24 hours in groups tests. According to the results, the severity of postoperative
nausea and vomiting at 6 and 24 hours after surgery showed that
in the group which administered ondansetron and aprepitant
6 hours after the operation was 3.01 with a standard deviation of simultaneously, the severity of nausea and vomiting is less than
1.71 (Fig. 2). The highest severity of nausea and vomiting was in the other two groups. The existence of two different mechanisms
subjects equal to 7 and lowest of zero. The mean severity of nausea of action for both ondansetron and aprepitant drugs can lead to
and vomiting during the 24 hours after the operation was 0.99 with the conclusion that co-administration of both drugs improves the
a standard deviation of 0.98 (Fig. 3). The highest severity of nausea outcome and reduces the incidence of vomiting in patients.
and vomiting was in patients equal to 3 and the lowest was zero. Comparing nausea and vomiting in other groups based on
Considering that the p-value of the one-way analysis of variance statistical tests, it was demonstrated that the level of nausea
is more than 0.05, it can be concluded that there is no significant and vomiting at 6 and 24 hours after surgery was significantly
difference between the studied groups in terms of the mean age, different between the groups of aprepitant and ondansetron, this
so the groups are conformed. difference in mechanism leads to different effects of these two
Considering that the amount of results from one-way analysis drugs, indicating that the blocking mechanism of the neurokinin
of variance is less than 0.05, it can be concluded that there is a receptor 1 has more effect on vomiting than the serotonin
significant difference between the groups in terms of severity of 5-HT3 receptor block pathway. On the other hand, there is not a
nausea and vomiting at 6 hours. significant difference in the rate of nausea and vomiting between
Considering the results of Tukey follow-up, it can be concluded the groups of aprepitant and the simultaneous aprepitant and
that there is a significant difference between the treatment group ondansetron group, which indicates the potent antiemetic effect
receiving ondansetron and the two other groups, thus the severity of the aprepitant.
of nausea and vomiting in the group receiving ondansetron is more As it was demonstrated, there is no significant relationship
than the other two groups. between age and severity of nausea and vomiting in different
Considering the result obtained from Kruskal–Wallis is less groups. Therefore, based on this study, it can be concluded that age
than 0.05, it can be concluded that there is a significant difference does not have a clear effect on nausea and vomiting after surgery.

World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021) 41