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Randomized Controlled Trial
. 2006 Aug 12;333(7563):324.
doi: 10.1136/bmj.38903.419549.80. Epub 2006 Jul 21.

Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial

Jan Wallenborn  1 , Götz Gelbrich, Detlef Bulst, Katrin Behrends, Hasso Wallenborn, Andrea Rohrbach, Uwe Krause, Thomas Kühnast, Martin Wiegel, Derk Olthoff
Affiliations
Randomized Controlled Trial

Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial

Jan Wallenborn et al. BMJ. .

Abstract

Objectives: 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.

Design: Four-armed, parallel group, double blind, randomised controlled clinical trial.

Setting: Four clinics of a university hospital and four district hospitals in Germany.

Participants: 3140 patients who received balanced or regional anaesthesia during surgery.

Main outcome measures: 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.

Conclusion: 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.

Trial registration: Current Controlled Trials ISRCTN31625370 [controlled-trials.com].

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Figures

Fig 1
Fig 1
Flow of participants through trial
Fig 2
Fig 2
Cumulative incidence of postoperative nausea and vomiting in four treatment groups
Fig 3
Fig 3
Rates of early and late postoperative nausea and vomiting and intraoperative adverse drug reactions (hypotension and tachycardia) in four treatment groups
See this image and copyright information in PMC

Comment in

References

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