[Prophylaxis of nausea and vomiting after pelviscopy. Dolasetron or MCP in comparison with placebo]

Abstract

Background: Gynaecological surgery including laparoscopy is frequently associated with PONV. Therefore, choosing an anaesthetic with only little side effects in operations eligible for outpatient surgery is at least as important as applying anaesthetics that enable fast-tracking.

Study goal: To assess the incidence and severity of PONV after balanced desflurane-N(2)O-anaesthesia and to compare the antiemetic efficacy of dolasetron or metoclopramide versus placebo.

Methods: 120 ASA physical status I and II women aged 18 to 55 scheduled for elective laparoscopic surgery were enrolled. Anaesthesia was standardized: fentanyl (2 microg/kg), etomidate (0. 25 mg/kg) and succinylcholine (1 mg/kg) for induction and desflurane 3-5% et along with 30% O(2) in N(2)O, fentanyl (max. 0.1 mg/h) and cis-atracurium for maintenance. Patients were randomly allocated to receive one of the following: dolasetron 12.5 mg (group-D), metoclopramide 10 mg (group-M) or placebo (group-P).

Results: Within the first 24 h, postoperative nausea (PON) and postoperative vomiting (POV) were reduced significantly in group D (38%/19%) and group M (36%/27%) compared to group P (69%/56%). Furthermore, PON and POV proved to be less intense in groups D and -M compared to group P: Episodes of severe nausea were recorded 17 times in 10 patients (17/10) in group P, compared to 5/4 in group M and 5/3 in group D, episodes of repeated vomiting 13 times in 8 patients (13/8) in group P, compared to 2/2 in group M and 2/1 in group D.

Conclusions: Our results confirm the increased incidence of PONV after gynaecological laparoscopic surgery under balanced anaesthesia compared to the predicted rates. Both dolasetron and metoclopramide proved to be effective prophylactic measures. Given a PONV-incidence of 38% in group D and 39% in group M, it is doubtful, whether the anaesthetic technique chosen in this study is the most suitable regimen for ambulatory gynaecological laparoscopies.