title: Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial.
abstract: OBJECTIVE
  To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions.
  
  
  METHODS
  Four-armed, parallel group, double blind, randomised controlled clinical trial.
  
  
  METHODS
  Four clinics of a university hospital and four district hospitals in Germany.
  
  
  METHODS
  3140 patients who received balanced or regional anaesthesia during surgery.
  
  
  METHODS
  Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions.
  
  
  RESULTS
  Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting (> 12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.
  
  
  CONCLUSIONS
  The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN31625370 [controlled-trials.com].
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, D-04103 Leipzig, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Wallenborn
authors.forename: Götz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Detlef
authors.initials: D
authors.lastname: Bulst
authors.forename: Katrin
authors.initials: K
authors.lastname: Behrends
authors.forename: Hasso
authors.initials: H
authors.lastname: Wallenborn
authors.forename: Andrea
authors.initials: A
authors.lastname: Rohrbach
authors.forename: Uwe
authors.initials: U
authors.lastname: Krause
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühnast
authors.forename: Martin
authors.initials: M
authors.lastname: Wiegel
authors.forename: Derk
authors.initials: D
authors.lastname: Olthoff
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage* / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D003907:Dexamethasone; D008787:Metoclopramide