Comparing the Efficacy of Dimenhydrinate-metoclopramide, Dimenhydrinate - Ondansetron and Dimenhydrinate Alone on Nausea and Vomiting after Cataract Surgery under Local Anesthesia and Intravenous Sedation

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Ophthalmology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Resident, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The study aimed to compare the efficacy of Dimenhydrinate-Metoclopramide, Dimenhydrinateondansetron and Dimenhydrinate alone on nausea and vomiting after cataract surgery under local anesthesia and intravenous sedation. 
Methods: In this clinical trial study, 160 patients undergoing cataract surgery were divided into four groups of 40. Thirty minutes before induction in the first group (D-M) 0.1mg/ kg metoclopramide + 0.5 mg/ kg Dimenhydrinate, in the second group (D-O) 0.4 mg/ kg ondansetron + 0.5 mg/ kg Dimenhydrinate, in the third group (D), 0.5mg/ kg Dimenhydrinate and in the fourth group (C) 2 cc of distilled water were injected and the incidence and severity of nausea and vomiting at recovery and 2 and 4 hours after surgery and at the time of discharge were evaluated and compared between groups.
Findings: The incidence of nausea at recovery in four groups of D-M, D-O, D and C were 13.2, 10.8, 22.2 and 36.1%, respectively, and the difference between the groups was significant (P = 0.015). In the next two hours, the incidence of nausea in the four groups was 10.8, 5.3, 22.2 and 27.9%, respectively (P = 0.035). The incidence of vomiting in recovery was 16.2, 7.9, 16.7 and 33.3% among the four groups, respectively (P = 0.039). Also the intensity of nausea in recovery were statistically different between 4 groups and the Dimenhydrinateondansetron group had the least severity of nausea. Pain intensity was lower in Metoclopramide receiving group.
Conclusion: Dimenhydrinate-ondansetron combination compared with Dimenhydrinate-metoclopramide and Dimenhydrinate alone led to an increased reduction of postoperative nausea and vomiting following cataract surgery. 

Keywords


  1. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Veder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Eng J Med 2004; 350(24): 2441-51.
  2. Moradi Farsani D, Alikiaei B, Hoseinzadeh F. Comparison of ondansetrone, metoclopramide and midazolam for preventing PONV prophylaxis after strabismus surgery. J Arak Uni Med Sci 2017; 20(2): 67-77. [In Persian].
  3. Shaikh SI, Nagarekha D, Hegade G, Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth Essays Res 2016; 10(3): 388-96.
  4. Tramèr MR. A rational approach to the control of postoperative nausea and vomiting: evidence from systemic reviews ΙΙ recommendations for prevention and treatment and research agenda. Acta anesthesiol Scand 2001; 45(1): 14-9.
  5. Maharjan S, Bing Z. Post-operative nausea and vomiting, its causes, and the way of its prevention and treatment. Birat J Health Sci 2021; 6(1): 1405-15.
  6. Darvall J, Handscombe M, Maat B, So K, Suganthirakumar A, Leslie K. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: An analysis of published studies. Can J Anaesth 2021, 68(7): 1057-63.
  7. Elsaid RM, Namrouti AS, Samara AM, Sadaqa W, Sa’ed HZ. Assessment of pain and postoperative nausea and vomiting and their association in the early postoperative period: an observational study from Palestine. BMC Surg 2021; 21(1): 177.
  8. Prakash K, Meshram T, Jain P. Midazolam versus dexamethasone‐ondansetron in preventing post‐operative nausea‐vomiting in patients undergoing laparoscopic surgeries. Acta Anaesthesiol Scand 2021; 65(7): 870-76.
  9. Shabanian G, Khoram B, Ganji F. The effect of metoclopramide addition to lidocaine on pain of patients with grades II and III post-episiotomy repair. J Clin Diagn Res 2017; 11(4): QC11-QC14.
  10. Farhat K, Pasha AK, Kazi WA. Comparison of ondansetron and metoclopramide for PONV prophylaxis in laparoscopic cholecystectomy. J Anesthe Clinic Res 2012; 4(3): 297.
  11. Isazadehfar K, Entezariasl M, Shahbazzadegan B, Nourani Z, Shafaee Y. The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Med Iran 2017; 55(4): 254-8.
  12. Kim SI, Kim SC, Baek YH, Ok SY, Kim SH. Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery. Br J Anaesth 2009; 103(4): 549-53.
  13. Kranke P, Morin AM, Roewer N, Eberhart LH. Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2002; 46(3): 238-44.
  14. Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 2002; 46(1): 109-13.
  15. Kizilcik N, Bilgen S, Menda F, Türe H, Aydın B, Kaspar EC, et al. Comparison of dexamethasone-dimenhydrinate and dexamethasone-ondansetron in prevention of nausea and vomiting in postoperative patients. Aesthetic Plast Surg 2017; 41(1): 204-10.
  16. 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. BMJ 2006; 333(7563): 324.
  17. Aouad MT, Siddik-Sayyid SM, Taha SK, Azar MS, Nasr VG, Hakki MA, et al. Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery. Eur J Anaesthesiol 2007; 24(2): 171-8.
  18. Marcus JR, Few JW, Chao JD, Fine NA, Mustoe TA. The prevention of emesis in plastic surgery: a randomized, prospective study. Plast Reconstr Surg 2002; 109(7): 2487-94.
  19. Quaynor H, Raeder JC. Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 2002; 46(1): 109-13.
  20. Rahimi-Varposhti M, Moradi-Farsani D, Salehnia A, Montazeri K, Shafa A. Effects of magnesium sulfate on pain, nausea/ vomiting, and anesthetic consumption after corneal transplantation and vitrectomy. J Isfahan Med Sch 2017; 35(423): 278-84. [In Persian].
  21. Naghibi K, Dodangeh M, Hashemi ST, Moradi-Farsani D. Evaluation and comparison of the effects of propofol, dexamethasone, and ondonestrone in the prevention of complications during and after cataract surgery. J Isfahan Med Sch 2018; 36(475): 372-8. [In Persian].