Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. A prospective randomized study of metoclopramide and transdermal hyoscine

Abstract

Objective: To compare the antiemetic effects of metoclopramide and hyoscine in patients after laparoscopic cholecystectomy.

Design: Prospective, randomised trial.

Setting: University hospital, Sweden.

Subjects: 100 consecutive patients median age 49 years (range 21-79) of whom 9 were withdrawn after randomisation.

Interventions: Patients were randomised to receive either four doses of metoclopramide 10 mg intravenously starting at the induction of anaesthesia (n = 44), or hyoscine transdermally through a patch placed behind the ear at 0600 h on the day of operation (n = 47).

Main outcome measures: The incidence of nausea and vomiting.

Results: Metoclopramide was significantly more effective at preventing both nausea and vomiting (20/44 (45%) compared with 32/47 (68%), p < 0.05, and 10/44 (23%) compared with 21/47 (45%), p < 0.05). Women were significantly more likely to become nauseated than men (46/66 (70%) compared with 5/25 (20%), p < 0.001). Two patients in the metoclopramide group developed dizziness, and one patient in the hyoscine group had a disturbance of vision. About 20% in each group required additional antiemetic treatment. The median hospital stay in both groups for patients who did not develop complications was 2 days.

Conclusion: There was a high incidence of nausea and vomiting after laparoscopic cholecystectomy even after treatment with metoclopramide. Further measures are indicated, particularly for women.