Oral comparable to intravenous ondansetron for PONV

Oral comparable to intravenous ondansetron for PONV




Orally disintegrating ondansetron is an effective alternative to intravenous ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy, say researchers.
Previous concerns regarding the oral route for ondansetron have included bioavailability and duration of efficacy, but the team found that oral ondansetron when administered pre-operatively prevented PONV for as long as 6 hours postoperatively.
“The patients usually tolerate oral intake by this time and can be administered another dose if the need arises postoperatively,” wrote Preethy Mathew and colleagues, from the Postgraduate Institute of Medical Education and Research in Chandigarh, India.
The researchers randomly assigned 109 patients scheduled for laparoscopic cholecystecotmy to receive oral ondansetron, intravenous oldansetron, or placebo to prevent PONV.
Surgery was converted to open cholecystectomy for six patients, leaving data on 103 for analysis.Duration of surgery, duration of anesthesia and time to recovery were comparable for the three groups.
The researchers report that patients taking placebo took a longer time to tolerate oral intake than those receiving oral or intravenous ondansetron, at an average of 366.1 minutes compared with 322.9 minutes and 322.4, respectively. They note that this was due to the higher incidence of nausea and vomiting in the placebo-treated group during the first 6 hours postoperatively compared with patients given oral or intravenous ondansetron, at 44.4% versus 17.7% and 18.2%, respectively.
Overall, 67.7% patients receiving oral ondansetron had no episodes of nausea or vomiting in the 24 hours after surgery. This was comparable to the 72.7% of patients receiving intravenous ondansetron and significantly different to the 47.2% of patients given placebo.
Patient satisfaction was also similar for oral and intravenous ondansetron, and significantly higher when compared with placebo.
“PONV are common and distressing complications and are the main concern of 40% to 70% of patients after laparoscopic surgery,” Mathew and co-workers highlight in the journal Anaesthesia.
“We conclude that orally disintegrating ondansetron is an effective alternative to intravenous ondansetron in preventing PONV in patients undergoing laparoscopic cholecystectomy.”