Dua N, Bhatnagar S, Mishra S, Singhal AK. Granisetron and ondansetron for prevention of nausea and vomiting in patients undergoing modified radical mastectomy
ABSTRACT Modified radical mastectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the comparative profile and efficacy of ondansetron and granisetron to prevent PONV after modified radical mastectomy. In a randomized, double-blind, placebo-controlled trial, sixty female patients received ondansetron 4 mg, granisetron 1 mg or saline intravenously just before induction of anaesthesia (n = 20 for each group). A standardized general anaesthetic technique was employed. The incidence of PONV and adverse events were recorded for the first 24h postoperatively. The incidence of PONV was 25% with ondansetron, 20% with granisetron and 70% with saline (P < 0.05, Chi-square test with Yates' correction factor). The incidence of adverse events was comparable among the groups. Ondansetron and granisetron are both effective for reducing the incidence of PONV in female patients undergoing modified radical mastectomy.
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ABSTRACT: Women undergoing general anaesthesia for breast surgery are especially at risk of experiencing postoperative nausea and vomiting (PONV). This study was undertaken to assess the efficacy of granisetron, a selective serotonin type 3 receptor antagonist, for the treatment of postoperative nausea and vomiting after breast surgery. This was a prospective, randomised, double-blind, placebo-controlled study carried out in a university-affiliated teaching hospital. The study included women who experienced nausea lasting >10 minutes and/or vomiting during the first 3 hours after recovery from anaesthesia for breast surgery. Patients intravenously received either placebo or granisetron at four different doses (10 microg/kg, 20 microg/kg, 40 microg/kg and 80 microg/kg). Patients were observed for 24 hours after administration of the study drug. A total of 100 women were enrolled in this study. Complete control of established PONV, defined as no emetic symptoms and no need for a rescue antiemetic, was observed in 50% of women receiving granisetron 10 microg/kg (p = 0.5 vs placebo), 85% of women receiving granisetron 20 microg/kg (p = 0.009 vs placebo), 90% of women receiving granisetron 40 microg/kg (p = 0.003 vs placebo), and 85% of women receiving granisetron 80 microg/kg (p = 0.009 vs placebo), compared with 45% of placebo recipients. The efficacies of granisetron 20 microg/kg, granisetron 40 microg/kg, and granisetron 80 microg/kg for the treatment of established PONV were superior to that of granisetron 10 microg/kg (all p < 0.05). No serious adverse effects were observed in any group. The minimum effective dose of granisetron for the treatment of PONV in women undergoing breast surgery was 20 microg/kg. Increasing the granisetron dose to 80 microg/kg provided no further benefit.Clinical Drug Investigation 02/2006; 26(4):203-8. DOI:10.2165/00044011-200626040-00004 · 1.70 Impact Factor
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ABSTRACT: Breast surgery performed under general anaesthesia is associated with a high incidence of postoperative nausea and vomiting (PONV). Between 60% and 80% of patients undergoing mastectomy (with axillary dissection) experience PONV. Pharmacological approaches have been investigated to reduce PONV after breast surgery. Traditional antiemetics (droperidol and metoclopramide) are frequently used for the prevention of PONV during the first 24 hours after anaesthesia. The available non-traditional antiemetics that have been shown to be effective for prophylaxis against PONV are dexamethasone, clonidine, propofol and supplemental oxygen. Antiserotonins (ondansetron, granisetron, tropisetron, dolasetron and ramosetron) are highly effective for preventing PONV for 24 hours postoperatively, compared with traditional antiemetics. Ramosetron is effective for the long-term (up to 48 hours) prevention of PONV. Better results can be obtained by combining antiemetics, because they have different sites of action. Combination antiemetic therapy is often effective for preventing PONV after breast surgery. Combinations of an antiserotonin (granisetron or dolasetron) and droperidol or dexamethasone are more effective than monotherapy with antiserotonins. A non-pharmacological technique is acupuncture at the P6 (Nei-Kuan) point. Overall, these pharmacological and non-pharmacological approaches reduce the incidence of PONV following breast surgery. Most of the published trials indicate improved prophylaxis of PONV following breast surgery by avoiding risk factors, and by using effective antiemetic agents in women scheduled for mastectomy (with axillary dissection). The clinician must weigh the benefits of using pharmacological and non-pharmacological approaches for PONV against the risk of occurrence of adverse events.Clinical Drug Investigation 02/2006; 26(8):427-37. DOI:10.2165/00044011-200626080-00001 · 1.70 Impact Factor