Prospective, randomized, double-blind, placebo-controlled comparison of metoclopramide and ondansetron for prevention of posttonsillectomy or adenotonsillectomy emesis.
OBJECTIVE
To compare the antimetic efficacy of prophylactic ondansetron, metoclopramide, and placebo for prevention of postoperative vomiting in pediatric tonsillectomy or adenotonsillectomy patients.


METHODS
Prospective, randomized, double-blind, placebo controlled study.


METHODS
Children's hospital.


METHODS
132 ASA status I and II children, ages 2 to 12 years, undergoing tonsillectomy or adenotonsillectomy.


METHODS
Patients received intravenous (IV) melodopramide 0.25 mg/kg, IV on dansetron 0.15 mg/kg, or IV saline placebo after induction of standardized halothane, nitrous oxide, and oxygen anesthesia. Muscle relaxants and their antagonists were allowed. Patients received postoperative analgesics as needed.


RESULTS
Incidence of postoperative vomiting, time of vomitting onset, and hospital length of stay (LOS) were measured. Patients who were admitted were excluded from LOS analysis. The postoperative incidence of vomiting was 54% for patients receiving metoclopramide, 26% for patients receiving ondansetron, and 69% for the placebo group. These differences were significant for ondansetron versus metoclopramide (p = 0.008) and placebo (p = 0.001). The mean (SD) LOS was significantly shorter for patients not vomiting 488 (88) minutes for vomiters versus 435 (65) minutes for non-vomiters.


CONCLUSIONS
Prophylactic ondansetron is more effective than metoclopramide or placebo for the prevention of vomiting after tonsillectomy or adenotonsillectomy. Patients who do not vomit postoperatively have shorter LOS.
Department of Anesthesiology, Children's Health Care-Minneapolis, MN 55404, USA.
F N
FN
Stene
R E
RE
Seay
L A
LA
Young
L E
LE
Bohnsack
B C
BC
Bostrom
D000233:Adenoidectomy / Q000009:adverse effects*; D000700:Analgesics / Q000627:therapeutic use; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006221:Halothane / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D007902:Length of Stay; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use*; D009609:Nitrous Oxide / Q000008:administration & dosage; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000008:administration & dosage; D010919:Placebos; D011183:Postoperative Complications; D011292:Premedication; D011446:Prospective Studies; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects*; D014839:Vomiting / Q000517:prevention & control*
D000700:Analgesics; D018685:Anesthetics, Inhalation; D000932:Antiemetics; D010919:Placebos; D017294:Ondansetron; D009609:Nitrous Oxide; D008787:Metoclopramide; D010100:Oxygen; D006221:Halothane