Geranisetron versus gabapentin in preventing postoperative nausea and vomiting after middle ear surgery in adults: A double-blinded randomized clinical trial study

Authors

Department of Anesthesia, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The incidence of postoperative nausea and vomiting (PONV) after middle ear surgery is high. In this study we want to compare the effects of intravenous granisetron and oral gabapentin as a premedication before surgery on the incidence and severity of PONV after middle ear surgery in adult patents. Materials and Methods: We enrolled 90 patients that were randomly divided into the three groups of 30 in each. Group I received granisetron 3 mg iv 2 minutes before induction of anesthesia; Group II received oral gabapentin 300 mg 1 hour before anesthesia and Group III received placebo. The incidence and severity of PONV were recorded each 15 minutes in the post-anesthesia care unit (PACU) and each 8 hours until 24 hours after discharge from the PACU. Result: The incidence and severity of nausea and vomiting at different time intervals in Groups I and Group II was significantly lower compared with Group III (P < 0.05). There was no significant difference in the incidence of side effects of study drug administration including respiratory depression, apnea, extra pyramidal disorders, drowsiness, dizziness, vertigo and headache in three groups. Conclusion: The study was shown that using gabapentin and granisetron have equal anti-emetic effects, but significant differences were seen between these two groups compared to the control group. These submit the efficiency of these drugs in preventing PONV.

Keywords

1. Miller RD. Anesthesia. In: Fleisher LA, Macario A. The postanesthesia care 
unit. 6th ed. Pennsylvania: Elsevier; 2010. p. 2703‑27.
2. HabibAS, Gan TJ. Evidence‑based management of postoperative nausea 
and vomiting: A review. Can J Anesth 2004;51:326‑41.
3. Kazemi‑Kjellberg F, Henzi I, Tramèr MR. Treatment of established 
postoperative nausea and vomiting: Aquantitative systematic review. BMC 
Anesthesiol 2001;1:2.
4. Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. 
Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 
1995;42:201‑3.
5. Korttila K, Alahuhta S, Ali‑Melkkila DT, Tarkkila DP, Hynynen DM. Prevention 
of postoperative nausea and vomiting‑studies on different antiemetics, their 
combinations and dosing regimens. Biomedicum Helsinki 2003;26:1‑78.
6. Kreis ME. Postoperative nausea and vomiting. Auton Neurosci 
2006;129:86‑91.
7. Sharma S, Abdullah N. A comparison of commonly used anti‑emetics for 
the prevention of emetic sequelae after a major gynaecological surgery. 
Singapore Med J 2000;41:147‑50.
8. Habib AS, White WD, Eubanks S, Pappas TN, Gan TJ. A randomized 
comparison of a multimodal management strategy versus combination 
antiemetics for the prevention of postoperative nausea and vomiting. Anesth 
Analg 2004;99:77‑81.
9. Bianchin A, De Luca A, Caminiti A. Postoperative vomiting reduction after 
laparoscopic cholecystectomy with single dose of dexamethasone. Minerva 
Anestesiol 2007;73:343‑6.
10. Jung JS, Park JS, Kim SO, Lim DG, Park SS, Kwak KH, et al. Prophylactic 
antiemetic effect of midazolam after middle ear surgery. Otolaryngol Head 
Neck Surg 2007;137:753‑6.
11. Buck DW, Mustoe TA, KimJY. Postoperative nausea and vomiting in plastic 
surgery. Semin in Plast Surg 2006;20:249‑55.
12. Rajesh P. Incidence of postoperative nausea and vomiting in elective 
oral and maxillofacial surgical procedure. Int J Oral Maxillofac Surg 
2007;36:1030.
[Downloaded free from http://www.advbiores.net on Tuesday, April 4, 2023, IP: 178.173.134.149]
Honarmand, et al.: Prevention of PONV in ear surgery
Advanced Biomedical Research | 2014 5
13. Heidari SM, Saryazdi H, Saghaei M. Effect of intravenous midazolam 
premedication on postoperative nausea and vomiting after cholecystectomy. 
Acta Anaesthesiol Taiwan 2004;42:77‑80.
14. Bauer KP, Dom PM, RamirezAM, O’Flaherty JE. Preoperative intravenous 
midazolam: Benefits beyond anxiolysis. J Clin Anesth 2004;16:177‑83.
15. Arif AS, Kaye AD, Frost E. Postoperative nausea and vomiting‑a review. 
Middle East J Anesthesiol 2001;16:127‑54.
16. Habib AS, Chen YT, Taquchi A, Hu XH, Gan TJ. Postoperative nausea and 
vomiting following inpatient surgeries in a teaching hospital: Aretrospective 
database analysis. Curr Med Res Opin 2006;22:1093‑9.
17. Grecu I, Vartic M, Avram V. A comparison of midazolam, droperidol and 
ondansetron in preventing postoperative nausea and vomiting after 
laparoscopic cholecystectomy. Eur J Anaesthesiol Suppl 2000;17:120.
18. Eberhart LH, MauchM, MorinAM, Wulf H,GeldnerG. Impact of a multimodal 
anti‑emetic prophylaxis on patient satisfaction in high‑risk patients for 
postoperative nausea and vomiting. Anaesthesia 2002;57:1022‑7.
19. Grabowshka‑GawełA. Postoperative nausea and vomiting (PONV)‑causes, 
prevention, treatement. Przegl Lek 2005;62:1517‑20.
20. Williams KS. Postoperative nausea and vomiting. Surg Clin North Am 
2005;85:1229‑41, xi.
21. Available from: http://www.rch.org.au/anaes/pain_management/
Postoperative_Nausea_Vomiting_PONV. [Last accessed on 2013 Feb 10].
22. Lee Y, Wang JJ, Yang YL, Chen A, Lai HY. Midazolam vs ondansetron for 
preventing postoperative nausea and vomiting: A randomised controlled 
trial. Anaesthesia 2007;62:18‑22.
23. Rodolà F. Midazolam as an anti‑emetic. Eur Rev Med Pharmacol Sci 
2006;10:121‑6.
24. Khademi S, Ghaffarpasand F, Heiran HR, Asefi A. Effects of preoperative 
gabapentin on postoperative nausea and vomiting after open 
cholecystectomy: Aprospective randomized double‑blind placebo‑controlled 
study. Med Princ Pract 2010;19:57‑60.
25. Papadima A, Gourgiotis S, Lagoudianakis E, Pappas A, Seretis C, 
Antonakis PT, et al. Granisetron versus tropisetron in the prevention of 
postoperative nausea and vomiting after total thyroidectomy. Saudi J 
Anaesth 2013;7:68‑74.
26. Riad W, Altaf R, AbdullaA, Oudan H. Effect of midazolam, dexamethasone 
and their combination on the prevention of nausea and vomiting following 
strabismus repair in children. Eur J Anaesthesiol 2007;24:697‑701.
27. Cho SY, Oh MK, Yeom JH, Shin WJ, Kim YC, Lee DH. The postoperative 
antiemetic effect of midazolam in patients undergoing appendectomy. 
Korean J Anesthesiol 1999;37:1095‑100.
28. Ganjare A, Kulkarni AP. Comparative electrocardiographic effects of 
intravenous ondansetron and granisetron in patients undergoing surgery 
for carcinoma breast: A prospective single‑blind randomised trial. Indian J 
Anaesth 2013;57:41‑5.
29. Pandey CK, Priye S, Ambesh SP, Singh S, Singh U, Singh PK. Prophylactic 
gabapentin for prevention of postoperative nausea and vomiting in patients 
undergoing laparoscopic cholecystectomy: A randomized, double‑blind, 
placebo‑controlled study. J Postgrad Med 2006;52:97‑100.
30. Pandey CK, Priye S, Singh S, Singh U, Singh RB, Singh PK. Preemptive use 
of gabapentin significantly decreases postoperative pain and rescue analgesic 
requirements in laparoscopic cholecystectomy. Can J Anaesth 2004;51:358‑63.
31. Kong VK, Irwin MG. Gabapentin: A multimodal perioperative drug? Br J 
Anaesth 2007;99:775‑86.