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Dolasetron, but not metoclopramide prevents nausea and vomiting in patients undergoing laparoscopic cholecystectomy

[Le dolasétron, non le métoclopramide, prévient les nausées et les vomissements chez des patients qui subissent une cholécystectomie laparoscopique]

From the Department of Anesthesiology and Critical Care, Medicine, Klinikum, Ludwigshafen, Ludwigshafen, Germany.

Address correspondence to: Dr. Swen N. Piper, Department of Anesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Bremserstraße 79, D-67063 Ludwigshafen, Germany. Phone: 0049/621/503-3000; Fax: 0049/621/503-3024; E-mail: swen.n.piper{at}t-online.de

Purpose: Postoperative nausea and vomiting (PONV) is one of the most frequent complications of general anesthesia. The aim of the study was to compare the antiemetic efficacy of dolasetron and metoclopramide after inhalational or iv anesthesia (IVA).

Methods: In a randomized, placebo-controlled, double-blinded trial we evaluated the efficacy of 12.5 mg dolasetron iv and 20 mg metoclopramide (MCP) iv in preventing PONV in 387 patients (ASA I–III) undergoing laparoscopic cholecystectomy. Patients were allocated randomly to one of three main groups: Group D (n = 129) received 12.5 mg dolasetron iv, Group MCP (n = 129) 20 mg MCP iv, and Group C (n = 129) saline as placebo iv. Using a multifactorial study design, one third of each main group (n = 43) was further randomized to receive either general anesthesia with desflurane, isoflurane or IVA with propofol and remifentanil. PONV, postoperative piritramide and droperidol consumption were documented.

Results: Independent from the anesthesia regimen chosen, dolasetron reduced PONV (19%) significantly compared to MCP (45%) and placebo (46%). Furthermore we could show a significant difference in the incidence of PONV between IVA (28%) and isoflurane (46%), but not in comparison to desflurane (36%). Patients receiving IVA had a higher postoperative piritramide consumption compared to the two other groups.

Conclusions: The results of our study suggest that dolasetron was more effective than MCP and placebo in preventing PONV. This action is independent of the anesthetic technique used.

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