Ondansetron for Prevention of Post-Operative Nausea and Vomiting (PONV) in General Surgery Patients

Aim: To determine the efficacy of single dose ondansetron in preventing PONV in patients. Methodology: In this cross sectional study 49 patients were given Ondansetron. Every patient was evaluated for PONV at 1, 2, 3, 6, 12 and 24 hours post operatively. This study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh. Results: A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), Original Research Article Naeem et al.; JPRI, 33(51B): 35-39, 2021; Article no.JPRI.77013 36 35% male and 65% female was included in this study. In this study ondansetron was given (N=49) 4 mg I/V before induction. Regarding complications there was not significant (p ≤0.05) POVN was observed. Conclusion: Our study results showed in patients who received ondansetron regarding frequency of post operative complications (PONV) showed insignificant results as no p-value is found to be ≤0.05.It was concluded that a single dose of ondansetron is very effective in preventing PONV in general surgery patients.


INTRODUCTION
Nausea and vomiting are most common postoperative complications and occur after local, regional and general anesthesia. Now in anesthetic practice several drugs e.g ketorolac, ondansetron, buprenophine, propofol and techniques (i.e spinal opoid administration, total intravenous anesthesia, patient control analgesia has become more commonly used practices [1,2]. Postoperative Nausea and Vomiting (PONV) are among the common stressful complications of surgery and anesthesia [3]. It may leads to amplified costs due to prolonged hospital stay. Precisely the laparoscopic surgeries are related with considerably high rate of PONV [2] due to creation of pneumoperitoneum during the procedure [4]. In high risk groups the incidence still remained around 80% despite use of modern anesthetic practices [5]. The cause of PONV is multifactorial and six independent factors which enable us to predict PONV are female gender, past history of PONV and motion sickness, use of opioids, nitrous oxide and non-smoking history [6,7]. A considerable proportion of patient experience PONV despite the widespread use of prophylactic antiemetics, including 5-HT3receptor antagonists [8,9].
Another study by Sanjowal et al revealed that complete response of 92% with ondansetron and dexamethasone combination [10,11].
The purpose to conduct this study was to determined the efficacy of ondansetron as in post-operative patients to reduce the nausea and vomiting as well as their prolong stay in hospital.

MATERIALS AND METHODS
This cross sectional study was conducted at General surgery operation theatres and surgical wards I, II, III and Department of Anaesthesia and SICU Peoples University of Medical & Health Sciences for women Nawabshah, District Shaheed Benazirabad, Sindh Pakistan. A written informed consent was taken from the patients. The patients of gender, age between 20-60 years with American Society of Anesthesiologists (ASA) type I & II were included in this study. Patients with history of previous exposure to general anaesthesia, upper gastro intestinal disease, motion sickness pregnancy and menstruation and those have taken antiemetic drugs pre operatively within 24 hours of operation were excluded from this study.
In this study 49 patients were selected who fulfill the inclusion and exclusion criteria. The sample size was calculated by using Rao software.
Research instrument was predesigned proforma, which incorporate clinical examination, relevant laboratory investigations, ASA score and postoperative outcome/ nausea & vomiting. All patients were kept nil by mouth for 8 hours before surgery. All monitoring equipments like pulse oximeter, noninvasive blood pressure & ECG monitors wire checked and applied to each patient on arrival to the operating room. A sample of 49 patients was received ondansetron 4 mg I/V before induction. Patients were transported to the recovery room and later to the ward after confirming an adequate level of consciousness and intact reflexes. The incidences of PONV was recorded within the first 24 hours after surgery at intervals of 0-2 hours, 3 hours, 6 hours, 12 hours and 24 hours. Episodes of PONV were identified by spontaneous complaints by the patients or by direct questioning. The results were analyzed by using SPSS-21 version and level of significance was kept at p-value ˂0.05.

RESULTS
A sample of 49 patients with age between 20-60 years (mean age 43.72±5.67 years), 35% male and 65% female was included in this study (Fig.  1).

Fig. 2. FREQUENCY OF POSTOPERATIVE COMPLICATIONS
There was observed no any patient (0% frequency) of postoperative complications (PONV) within 1 hour. After one hour vomiting was observed in 4.08% patients with 2.04% nausea complain. After 2hrs vomiting was observed in 6.12% patients while nausea in 8.16% patients. After 3 hrs nausea and vomiting was observed in 4.08% patients. PONV was observed 6.12% after 6 hrs. After 12 hrs 4.08% and 2.04% nausea and vomiting was observed respectively (Fig. 2). After 24 hrs no nausea and vomiting was observed in any patient.

CONCLUSION
It was concluded that the incidence of PONV was significantly lower after using ondansetron within 24 hrs.

CONSENT
All authors declare that 'written informed consent was obtained from the patient.