Main Article Content
postoperative nausea and vomiting, antiemetic
Background: Postoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable experience that significantly detracts patient's quality of life after surgery. Symptoms affecting patients undergoing abdominal surgery under general anaesthesia. It is also associated with complications such as gastric aspiration, bleeding, dehydration, wound dehiscence and delayed hospital discharge. Use of volatile anesthetic agents, prolonged duration of surgery, pain/anxiety, women, nonsmokers, obesity, use of opioids are certain factors which are proven to increase the incidence of PONV. The present study compared the antiemetic effect of ondansetron versus propofol for prevention of postoperative nausea and vomiting in patients undergoing open abdominal surgery under general anaesthesia.
Objectives: ‘’To study the antiemetic properties of propofol in abdominal surgeries’’
Methods: This study was conducted in the Department of Anaesthesiology & Critical Care, Dr. S. N. Medical College, and Jodhpur after obtaining institutional ethical committee approval and written informed consent from study subjects. Patients meeting the inclusion criteria were included in the study between august 2021 to January 2022. This was a prospective Double Blind Randomized Comparative Trial. The patients were divided into two groups of 35 each and were allocated to the groups by computer generated random number table method as follows:
- Group P: Patients receiving Propofol
- Group O: Patients receiving Ondansetron
In the post-operative period, incidence of nausea and vomiting was diagnosed by the use of PONV score and VNRS scale and sedation by Ramsay sedation score for postop till stay in PACU, along with Aldrete score for discharging patients from PACU. Time for extubation and time for need of first rescue antiemetic after extubation was noted. The incidence of PONV and mean total frequency of rescue antiemetic used in 24 hour postoperatively among the two groups was compared.
Results & Discussion -
Results were analysed statistically and were discussed as under. Demographics and Haemodynamic changes were minimal between both groups and statistically not significant. At time 0hr, 2hr, 4hr, 6hr, 12hr and 24 hr postoperatively we compared nausea and vomiting score in patients of P and O group. It is statistically not significant (P>0.05) in terms of requirement of mean dose of rescue antiemetic 24 hrs postop. Incidence of PONV is statistically significant at 5-6hr for group P and at 6-7 hour for group O postoperatively. So sub hypnotic dose of propofol 30 mg is comparable to ondansetron for reducing the incidence of nausea and vomiting in abdominal surgeries for first 6 hours, when they administered as a bolus 15-20 minutes before skin closure in adults undergoing abdominal surgeries under sevoflurane anaesthesia. Time for extubation in group O was 14.31±1.15 mints and in group P was 14.6±2.00 minutes. Time to stay in PACU after recovery room discharge was 83.91±9.22 minutes in group O and 81.45±7.29 in group P. Both results are comparable in both groups and statistically not significant. Time for first rescue antiemetic dose in group O was 7.18±0.76 hrs. and in group P, it was 5.55±0.52 hours. So we can infer that patients with propofol as antiemetic for postop PONV prophylaxis requires rescue antiemetic earlier than patients with ondansetron as prophylaxis. Mean Sedation score in first two hours postop was 1.31±0.47 in group O and 1.49±0.51 in group P, Mean Aldrete score for discharge from PACU for first two hours postop was 9.54±0.51 in group O and 9.4±0.5 in group P. Both results are comparable in both groups and statistically not significant. Difference in the overall incidence of side effects observed of both groups was statistically insignificant (P> 0.05).
Conclusion: From this study it can be concluded that sub hypnotic dose of propofol is comparable to ondansetron as conventional therapy for preventing PONV in patients undergoing general anaesthesia for abdominal surgery in terms of incidence and severity of nausea and vomiting and requirement of rescue antiemetic.
2. Hailu Yimer, Nugusu Ayalew, Zewditu Abdisa, Adugna Aregawi, Effect of sub-hypnotic dose of propofol on prevention of postoperative nausea and vomiting as part of multimodal antiemetic in patients undergoing open abdominal surgery: A prospective cohort study, Gondar University Hospital, Northwest Ethiopia, 2016 International Journal of Surgery Open,Volume 10.
3. Mehernoor F. Watcha, Paul F. White; Postoperative Nausea and Vomiting: Its Etiology, Treatment, and Prevention. Anesthesiology 1992; 77:162–184.
4. Kim, Eu-Gene et al. "Antiemetic effect of propofol administered at the end of surgery in laparoscopic assisted vaginal hysterectomy." Korean journal of anesthesiology vol. 66, 3 (2014): 210-5.
5. Safavi MR, Honarmand A. Low dose intravenous midazolam for prevention of PONV, in lower abdominal surgery-preoperative vs intraoperative administration. Middle East J Anesthesiol. 2009; 20:75–81.
6. Honarmand A, Safavi M, Khalili G, Mohammadnejad F. Prophylactic administration of haloperidol plus midazolam reduces postoperative nausea and vomiting better than using each drug alone in patients undergoing middle ear surgery. Saudi J Anaesth. 2012; 6:145–51.
7. Jabalameli M, Honarmand A, Safavi M, Chitsaz M. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron, and a combination. Adv Biomed Res. 2012; 1:2.
8. Safavi M, Honarmand A, Habibabady MR, Baraty S, Aghadavoudi O. Assessing intravenous ketamine and intravenous dexamethasone separately and in combination for early oral intake, vomiting and postoperative pain relief in children following tonsillectomy. Med Arh. 2012; 66:111–5.
9. Heidari SM, Talakoub R, Yaraghi Z. Comparing the preventive effect of midazolam and midazolam-dexamethasone on postoperative nausea and vomiting in elective middle ear surgery. Adv Biomed Res. 2012; 1:9.
10. Heidari SM, Saghaei M, Shafiee Z. Effect of preoperative volume loading on the intraoperative variability of blood pressure and postoperative nausea and vomiting. Med Arh. 2012; 66:94–6.
11. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91:693–700.
12. Mehernoor F. Watcha, Paul F. White; Postoperative Nausea and Vomiting: Its Etiology, Treatment, and Prevention. Anesthesiology 1992; 77:162–184.
13. Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists’ vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth. 2000; 47(10):1008-18.
14. Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology. 1994 Oct; 81(4):1005-43.
15. Levine PA, Bauchner H. Notice of retraction: “Prevention of postoperative nausea and vomiting with antiemetics in patients undergoing middle ear surgery: Comparison of a small dose of propofol with droperidol or metoclopramide” (Arch Otolaryngol Head Neck Surg. 2001; 127:25-28) Arch Otolaryngol Head Neck Surg. 2012;138:692.
16. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth ● Analg 1999; 89:652
17. Hasler WL, Chey WD. Nausea and vomiting. Gastroenterology. 2003 Dec; 125(6):1860–7.
18. Andrews, P.L.R.; Hawthorn, J. (1988). 8 The neurophysiology of vomiting. , 2(1), 141–168.
19. Shaikh, S. I., Nagarekha, D., Hegade, G., & Marutheesh, M. (2016). Postoperative nausea and vomiting: A simple yet complex problem. Anesthesia, essays and researches, 10(3), 388–396.
20. Koch, Kenneth L.; Hasler, William L. (2017). Nausea and Vomiting || the Physiology of Vomiting., 10.1007/978-3-319-34076-0(Chapter 2), 15–25.
21. Watcha MF White PF Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992; 77: 162-184
22. POST-OPERATIVE NAUSEA AND VOMITING (PONV): A REVIEW ARTICLE Dr. Saeeda Islam1 Dr. P. N. Jain2 DA, JAIN Indian J. Anaesth. 2004: PONV: A REVIEW; 48 (4) : 253-258
23. Srilata, M. (2016). Complications in Neuroanesthesia || Nausea and Vomiting., (), 345–357. doi:10.1016/b978-0-12-804075-1.00036-5
24. Rickford JK, Speedy HM, Tytler JA, Lim M. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy. Ann R Coll Surg Engl. 1988; 70:69–73
25. Dent SJ, Ramachandra V, Stephen CR. Postoperative vomiting: Incidence, analysis, and therapeutic measures in 3,000 patients. Anesthesiology. 1955; 16:564–72
26. Bonica JJ, Crepps W, Monk B, Bennett B. Postanesthetic nausea, retching and vomiting; evaluation of cyclizine (marezine) suppositories for treatment. Anesthesiology. 1958; 19:532–40.
27. Crocker JS, Vandam LD. concerning nausea and vomiting during spinal anesthesia. Anesthesiology. 1959; 20:587–92.
28. Ratra CK, Badola RP, Bhargava KP. A study of factors concerned in emesis during spinal anaesthesia. Br J Anaesth. 1972; 44:1208–11.
29. Wallenborn J, Gelbrich G, Bulst D, Behrends K, Wallenborn H, Rohrbach A, et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomized double blind multicentre trial. BMJ 2006; 333:324.
30. Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020; 131(2):411–448.
31. Rowbotham DJ. Current management of postoperative nausea and vomiting. Br J Anaesth 1992; 69:46S–59S.
32. Wilhelm SM, Dehoorne-Smith ML, Kale-Pradhan PB. Prevention of postoperative nausea and vomiting. Ann Pharmacother 2007; 41:68–78.
33. Sébastien Pierre, MD, Rachel Whelan, Nausea and vomiting after surgery, Continuing Education in Anaesthesia Critical Care & Pain, Volume 13, Issue 1, February 2013, Pages 28–32,
34. Wilde MI, Markham A. Ondansetron. A review of its pharmacology and preliminary clinical findings in novel applications. Drugs. 1996 Nov;52(5):773-94
35. Griddine A, Bush JS. Ondansetron. [Updated 2021 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
36. National Center for Biotechnology Information (2022). PubChem Compound Summary for CID 4943, Propofol. Retrieved February 2, 2022
37. Folino TB, Muco E, Safadi AO, et al. Propofol. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
38. Miller RD, editor. Miller’s anesthesia. Eighth edition. Philadelphia, PA: Elsevier/Saunders; 2015. 2 p.
39. Isola S, Hussain A, Dua A, et al. Metoclopramide. [Updated 2021 Oct 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
40. National Center for Biotechnology Information. PubChem Compound Summary for CID 4168, Metoclopramide Accessed Feb. 3, 2022.
41. Pierre S, Benais H, Pouymayou J. Apfel's simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anaesth. 2002 Mar;49(3):237-42.
42. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, Zernak C, Danner K, Jokela R, Pocock SJ, Trenkler S, Kredel M, Biedler A, Sessler DI, Roewer N; IMPACT Investigators. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004 Jun 10; 350(24):2441-51.
43. Silva AC, O'Ryan F, Poor DB. Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review. J Oral Maxillofac Surg. 2006 Sep;64(9):1385-97
44. Grabowska-Gaweł A, Porzych K, Piskunowicz G. Czynniki ryzyka i czestość wystepowania pooperacyjnych nudności i wymiotów u chorych operowanych w znieczuleniu ogólnym [Risk factors and frequency of postoperative nausea and vomiting in patients operated under general anesthesia]. Przegl Lek. 2006; 63(2):72-6. Polish.
45. Wallenborn J, Rudolph C, Gelbrich G, Goerlich TM, Helm J, Olthoff D. The impact of isoflurane, desflurane, or sevoflurane on the frequency and severity of postoperative nausea and vomiting after lumbar disc surgery. J Clin Anesth. 2007 May; 19(3):180-5.
46. Bhattarai, B., Shrestha, S., & Singh, J. (2011). Comparison of ondansetron and combination of ondansetron and dexamethasone as a prophylaxis for postoperative nausea and vomiting in adults undergoing elective laparoscopic surgery. Journal of emergencies, trauma, and shock, 4(2), 168–172.
47. Zhang, D., Shen, Z., You, J., Zhu, X., & Tang, Q. F. (2013). Effect of ondansetron in preventing postoperative nausea and vomiting under different conditions of general anesthesia: a preliminary, randomized, controlled study. Upsala journal of medical sciences, 118(2), 87–90.
48. Wilson EB, Bass CS, Abrameit W, Roberson R, Smith RW. Metoclopramide versus ondansetron in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy. Am J Surg. 2001 Feb;181(2):138-41
49. Fujii Y, Itakura M. Comparison of propofol, droperidol, and metoclopramide for prophylaxis of postoperative nausea and vomiting after breast cancer surgery: a prospective, randomized, double-blind, placebo-controlled study in Japanese patients. Clin Ther. 2008 Nov;30(11):2024-9
50. Naghibi K, Kashefi P, Azarnoush H, Zabihi P. Prevention of postoperative nausea and vomiting with a subhypnotic dose of Propofol in patients undergoing lower abdominal surgery: A prospective, randomized, double-blind study. Adv Biomed Res. 2015; 4:35. Published 2015 Feb 11.
51. Kampo S, Afful AP, Mohammed S, Ntim M, Buunaaim ADB, Anabah TW. Sub-hypnotic dose of propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section - a randomized control trial. BMC Anesthesiol. 2019 Sep 14; 19(1):177.
52. L.A. Rosillo-Meneses, O. Carrillo-Torres, P. Gonzalez-Navarro, J.A. Garcia-Garcia, Comparison of the antiemetic efficacy of propofol versus ondansetron in nasal surgery. Randomised clinical trial, Revista Médica del Hospital General de México,Volume 81, Issue 2, 2018, Pages 72-78, ISSN 0185-1063,
53. Hailu Yimer, Nugusu Ayalew, Zewditu Abdisa, Adugna Aregawi, Effect of sub-hypnotic dose of propofol on prevention of postoperative nausea and vomiting as part of multimodal antiemetic in patients undergoing open abdominal surgery: A prospective cohort study, Gondar University Hospital, Northwest Ethiopia, 2016, International Journal of Surgery Open, Volume 10, 2018, Pages 15-20, ISSN 2405-8572,
54. Kranke P, Röhm KD, Diemunsch P, Gan TJ, Apfel CC, Eberhart L, et al. Intravenous buspirone for the prevention of postoperative nausea and Vomiting. Eur J Clin Pharmacol 2012; 68:1465‐72.
55. Baxter AL, Watcha MF, Baxter WV, Leong T, Wyatt MM. Development and validation of a pictorial nausea rating scale for children. Pediatrics. 2011; 127:e1542–e1549.
56. Gan TJ, Glass PS, Howell ST, Canada AT, Grant AP, Ginsberg B. Determination of plasma concentrations of propofol associated with 50% reduction in post-operative nausea. Anesthesiology 1997; 87:779e84.
57. Karlida ̆g T, Kaygusuz I, Bestas ̧ A, et al. The efficacy of droperidol, metoclopramide, propofol, and ondansetron for the prevention of nausea and vomiting following middle ear surgery. Kulak Burun Bogaz Ihtis Derg. 2002; 9:331---6.
58. Splinter WM, Rhine EJ, Roberts DJ. Vomiting after strabismus surgery in children: ondansetron vs propofol. Can J Anaesth.1997; 44:8259.
59. J.Antonio Aldrete, The post-anesthesia recovery score revisited, Journal of Clinical Anesthesia, Volume 7, Issue 1, 1995, Pages 89-91.