PONV PREVENTION IN GENERAL ANESTHESIA PATIENTS : A BETTER CHOICE,

ONDANSETRON IV OR METOCLOPRAMIDE IV? A SYSTEMATIC REVIEW

YOHANES SUANDRIANNO , STEVEN YOE, FABIOLA VANIA FELICIA

Alumni of Atma Jaya Medical Faculty

OBJECTIVES

The objective of this study is to analyse the efficacy, based on cost and result, and pick a better
choice for PONV (Postoperative Nausea and Vomitting) prevention in general anesthesia
patients.

MATERIALS AND METHOD

An electronic literature search was performed by using Proquest, NCBI, and EBSCO (until
25thMay 2017) by using combination of keywords: ondansetron, metoclopramide, PONV,
prevention, general, and anesthesia. A total of 396 articles found, 11 articles met the criteria and
analysed further.
 RESULTS

Ondansetron is more superior than metoclopramide in managing PONV.

Author / Year D e s i g n Type of Procedure Total Sample P O N V P r e v a l e n c e

Ondansetron Metoclopramide Placebo
Raphael et al/19931 Clinical Trial gynaecological laparoscopic surgery 123 11 (18%) 3 3 ( 5 3 % ) Not stated
Diemunsch et al / 19972 Clinical Trial general anaesthesia for any type of surgical procedure 746 157 (41%) 2 1 5 ( 5 9 % ) Not stated
Polati et al / 19973 Clinical Trial gynaecological surgery 175 4 (6,9%) 1 9 ( 3 3 , 3 % ) 39 (65%)
Morris et al/19984 Clinical Trial gynaecological surgery 1044 195 (56%) 2 1 9 ( 6 3 % ) 261 (75%)

Krobbuaban et al/20085 Clinical Trial gynecological surgery 380 89 (47%) 115 (60% ) Not stated
Oksuz et al / 20076 Clinical Trial laparoscopic cholecystectomy 7 5 3 (12%) 1 1 ( 4 4 % ) Not stated
Kaki AM / 20087 Clinical Trial laparoscopic cholecystectomy 7 5 5 (20%) 7 ( 2 8 % ) 7 (28%)
Bilgin et al / 20108 Clinical Trial gynaecological surgery 160 4 (10%) 6 ( 1 5 % ) 18 (45%)
Ekinci et al/20119 Clinical Trial gynaecological surgery 100 3 (15%) 5 ( 2 5 % ) 12 (60%)

Talesh et al/201110 Clinical Trial Maxillofacial surgery 179 11 (11%) 2 2 ( 2 8 % ) Not stated

Isazadehfar et al/201711 Comparative Study laparoscopic cholecystectomy 6 0 10 (33,3%) 13 (43,3%) Not stated

CONCLUSION

For the treatment of PONV, the recommended ondansetron dose (4mg) is safe and well
tolerated. Compared with metoclopramide 10mg, ondansetron produces higher patient
satisfaction scores, and an increased incidence of freedom from nausea 24 hours after
administration.

REFERENCE

1. JH, Raphael et al. Antiemetic efficacy of prophylactic ondansetron in laparoscopic

surgery: randomized, double-blind comparison with metoclopramide. 15th May 2017.
https://www.ncbi.nlm.nih.gov/pubmed/8280551.

2. Diemunsch et al. Ondansetron compared with metoclopramide in the treatment of

established postoperative nausea and vomiting. 10th May
2017.http://web.a.ebscohost.com/ehost/detail/detail?sid=04b1d061-32ea-42dd-87f5-
02ccc6c2410a%40sessionmgr4007&vid=0&hid=4001&bdata=JnNpdGU9ZWhvc3QtbGl2
ZQ%3d%3d#AN=9389849&db=mdc.
3. Polati et al. Ondansetron versus metoclopramide in the treatment of postoperative
nausea and vomiting.12th May
2017.http://web.a.ebscohost.com/ehost/detail/detail?sid=2e304b25-38ec-4ade-9c05-
dcd9f24a0fe9%40sessionmgr4009&vid=0&hid=4001&bdata=JnNpdGU9ZWhvc3QtbGl2
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4. Morris et al. International, multicentre, placebo-controlled study to evaluate the

effectiveness of ondansetron vs. metoclopramide in the prevention of post-operative
nausea and vomiting.24th May 2017.https://www.ncbi.nlm.nih.gov/pubmed/9522145.

5. Krobbuaban et al. Ondansetron vs. metoclopramide for the prevention of nausea and
vomiting after gynecologic surgery. 3rd May
2017.https://www.ncbi.nlm.nih.gov/pubmed/18672630.

6. Oksuz et al. Comparison of the effectiveness of metoclopramide, ondansetron, and

granisetron on the prevention of nausea and vomiting after laparoscopic
cholecystectomy. 1st May 2017.
http://web.a.ebscohost.com/ehost/detail/detail?sid=e7549fc5-68fe-4e57-beb3-
96a752326180%40sessionmgr4007&vid=0&hid=4001&bdata=JnNpdGU9ZWhvc3QtbGl
2ZQ%3d%3d#AN=18158814&db=mdc.

7. Kaki et al. Prophylaxis of postoperative nausea and vomiting with ondansetron,

metoclopramide, or placebo in total intravenous anesthesia patients undergoing
laparoscopic cholecystectomy. 21st May
2017.https://www.ncbi.nlm.nih.gov/pubmed/18946563.

8. Bilgin et al. A comparative study of the antiemetic efficacy of dexamethasone,

ondansetron, and metoclopramide in patients undergoing gynecological surgery.22nd
May 2017. http://web.a.ebscohost.com/ehost/detail/detail?sid=7a0b79ca-c407-4648-
9b1f-
efb08519da10%40sessionmgr4008&vid=0&hid=4001&bdata=JnNpdGU9ZWhvc3QtbGl2
ZQ%3d%3d#AN=20581776&db=mdc.

9. Ekinci et al. A Randomized Comparison of Droperidol, Metoclopramide, Tropisetron,

and Ondansetron for the Prevention of Postoperative Nausea and Vomiting. 23rd May
2017.http://search.proquest.com/docview/843428461/abstract/96EC083AFEC346F2PQ/
9?accountid=48149.
10. Talesh et al. Comparison of ondansetron and metoclopramide antiemetic prophylaxis in
maxillofacial surgery patients. 17th May
2017.https://www.ncbi.nlm.nih.gov/pubmed/20674417.

11. Isazadehfar et al. The Comparative Study of Ondansetron and Metoclopramide Effects
in Reducing Nausea and Vomiting After Laparoscopic Cholecystectomy. 7th May
2017.http://search.proquest.com/docview/1899783757/96EC083AFEC346F2PQ/6?acco
untid=48149.