Evaluation of the Efficacy and Safety of Ramosetron versus Ondansetron for prevention of postoperative nausea and vomiting in gynaecological surgery
Authors: Dinesh Govinda Rao, Basavaraj SC
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Context: Postoperative Nausea and Vomiting (PONV) is a frequent and distressing complication after anaesthesia and surgery with a reported incidence of 20-30% and up to 80% in high-risk cases. It results in increased morbidity, prolonged hospital stay and increased healthcare costs. The multifactorial aetiology of PONV necessitates a combination of prophylactic antiemetic agents to prevent it.
Aims: In our study, we compared the efficacy of a combination of dexamethasone and 5HT3 receptor antagonist (Ondansetron or Ramosetron) in preventing PONV in patients undergoing gynaecological surgeries under subarachnoid block.
Settings and Design: Prospective, randomised, double blind controlled clinical study. Methods and Material:60 patients between the ages of 20 and 60 years with ASA physical status class I and II, undergoing elective total abdominal hysterectomy under subarachnoid block were selected and divided randomly into two groups of 30 members each. Group OD received Inj. Ondansetron 4 mg IV and Group RD received Inj. Ramosetron 0.3 mg IV, 20 minutes before completion of surgery. Inj. Dexamethasone 8 mg IV was given to patients in both groups immediately before spinal anaesthesia. PONV was assessed using a 4-point scoring system for 0-6, 6-12, 12-18 and 18-24 hours observational periods postoperatively. Incidence of nausea, vomiting, retching and other adverse effects were recorded.
Statistical analysis used: analysis of variance, x2 test, two-tailed Fisher’s exact probability test, or the Mann-Whitney U-test, as appropriate.
Results: Both groups of patients had significantly low incidence of PONV across all four observation periods with no statistically significant difference between groups OD and RD. In the overall 24 hour postoperative period, 84% of subjects in group OD and 94% in group RD showed a complete response to the prophylactic combination antiemetic therapy with no need for rescue antiemetic therapy.
Conclusions: Combination of 5HT3 receptor antagonist with Dexamethasone reduces the incidence of PONV in the 24 hour period after elective gynaecological surgery under subarachnoid block. Combining Ramosetron with Dexamethasone showed a significantly higher complete response than Ondansetron and Dexamethasone.