Randomized, placebo-controlled trial of combination antiemetic prophylaxis for day-case gynaecological laparoscopic surgery.
In a randomized, double-blind trial, we compared i.v. ondansetron 4 mg (control), i.v. ondansetron 4 mg and cyclizine 50 mg (combination) and i.v. saline 0.9% (placebo), given after induction of standardized anaesthesia, for the prevention of nausea and vomiting (PONV) after day-case gynaecological laparoscopic surgery. Compared with placebo, fewer patients in the control group vomited (9/20 versus 11/59, P = 0.02) or needed rescue antiemetic (7/20 versus 9/59, P = 0.06) before discharge. Compared with the control, fewer patients in the combination group (n = 60) vomited (11/59 versus 2/60, P = 0.01) or needed rescue antiemetic (29/59 versus 2/60, P = 0.03) before discharge. The incidence of vomiting in the combination group was less than 5% overall. Compared with the control, the combination group had a significantly lower incidence (P = 0.001) and severity (P < 0.001) of nausea after discharge and more patients with no PONV at any time during the study (15/59 versus 27/60, P = 0.03). Unlike the placebo and control groups, no patient receiving combination prophylaxis was admitted overnight for PONV management.
Ahmed
A B
AB
University Department of Anaesthesia and Intensive Care, Queen's Medical Centre, Nottingham, UK.
Hobbs
G J
GJ
Curran
J P
JP
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use*; D003501:Cyclizine / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D010535:Laparoscopy; D017294:Ondansetron / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D012702:Serotonin Antagonists / Q000627:therapeutic use; D016896:Treatment Outcome
D000932:Antiemetics; D006634:Histamine H1 Antagonists; D012702:Serotonin Antagonists; D017294:Ondansetron; D003501:Cyclizine