title: Comparison of metoclopramide and ondansetron for the prevention of nausea and vomiting after intrathecal morphine.
abstract: Nausea and vomiting remain unpleasant side effects of intrathecal (i.t.) morphine and of the numerous therapies tried, only prophylactic intravenous (i.v.) metoclopramide has been reported to be promising. Seventy-three patients, scheduled for orthopaedic prosthesis surgery of the hip or knee were studied. They received 4 mL of plain bupivacaine and 0.3 mg of preservative-free morphine i.t. for anaesthesia. The test drugs given in a double-blind and randomized fashion, were either metoclopramide 20 mg, three times, at 6 h intervals (23 patients), ondansetron, 8 mg, twice, at 12 h intervals (25 patients), or 0.9% saline three times, at 6 h intervals (25 patients). The occurrence of nausea, vomiting and pain was followed for 24 h. The incidences of nausea and vomiting were 60% (15/25) and 56% (14/25) in the saline group, 52% (12/23) and 48% (11/23) in the metoclopramide group, and 52% (13/25) and 40% (10/25) in the ondansetron group. Incidences of severe vomiting were 24, 35 and 12% respectively. Eight patients in the saline group, seven in the metoclopramide and 10 in the ondansetron group did not need additional opioids for post-operative pain relief. We conclude that, metoclopramide and ondansetron were not better than saline in the prevention of post-operative emesis induced by intrathecal morphine.
authors.affiliation: Department of Anaesthesia, Helsinki University Central Hospital, Finland.
authors.forename: M T
authors.initials: MT
authors.lastname: Pitkänen
authors.forename: M K
authors.initials: MK
authors.lastname: Numminen
authors.forename: M K
authors.initials: MK
authors.lastname: Tuominen
authors.forename: P H
authors.initials: PH
authors.lastname: Rosenberg
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006615:Hip / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal; D007717:Knee / Q000601:surgery; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D017294:Ondansetron / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D017294:Ondansetron; D009020:Morphine; D008787:Metoclopramide