 |
|
Efficacy of Ondansetron and Prochlorperazine for the Prevention of Postoperative Nausea and Vomiting After Total Hip Replacement or Total Knee Replacement Procedures
A Randomized, Double-blind, Comparative Trial
Jack J. Chen, PharmD;
David G. Frame, PharmD;
T. Jeffery White, PharmD
Arch Intern Med. 1998;158:2124-2128.
Background Limited data are available on the efficacy of ondansetron hydrochloride compared with prochlorperazine maleate for the treatment of postoperative nausea and vomiting (PONV).
Objective To evaluate the comparative efficacy of ondansetron and prochlorperazine for the prophylaxis of PONV in patients undergoing total hip replacement or total knee replacement procedures.
Methods A randomized, double-blind, comparative trial was conducted at a tertiary care, university hospital. Seventy-eight patients undergoing elective total hip or total knee replacement procedures received a single dose of ondansetron hydrochloride (n=37), 4 mg intravenously, or prochlorperazine maleate (n=41), 10 mg intramuscularly, at the end of the surgical procedure. Rescue therapy was administered every 4 hours as needed during the initial 48 hours. Primary outcome measures were the incidences and severity of PONV. Secondary outcome measures included the number of rescue antiemetic doses required, number of physical therapy cancellations because of PONV, length of hospital stay, and cost of antiemetic agents administered.
Results The incidence of nausea was significantly greater in the ondansetron group compared with the prochlorperazine group (81% vs 56%; odds ratio, 3.4; 95% confidence interval, 1.2-9.4) as was the severity of nausea (P=.04). Multivariate analysis identified administration of ondansetron, history of PONV, obesity, and female sex as risk factors for a nausea event. The incidence of vomiting tended to be greater in the ondansetron group (49% vs 32%; odds ratio, 2.0; 95% confidence interval, 0.8-5.0). The need for rescue antiemetic therapy was also greater in the ondansetron group (46% vs 27%; odds ratio, 2.3; 95% confidence interval, 0.9-6.0). The mean antiemetic drug cost per patient was significantly greater for the ondansetron group ($47.56 vs $2.47; P<.001). However, the proportion of patients who were unable to participate in physical therapy because of PONV and the median length of hospital stay were similar in both groups.
Conclusion Prochlorperazine is associated with superior efficacy and significant cost savings compared with ondansetron for the prevention of PONV in patients undergoing total hip and total knee replacement procedures.
From the Department of Pharmacy, Rush–Presbyterian–St Luke's Medical Center, Chicago, Ill (Drs Chen and Frame), and the Department of Pharmaceutical Economics and Policy, University of Southern California School of Pharmacy, Los Angeles (Dr White). Dr Chen is now with the Department of Pharmacy, Huntington Memorial Hospital, Pasadena, Calif.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting
Gan et al.
Anesth. Analg. 2007;105:1615-1628.
ABSTRACT
| FULL TEXT
Evidence-based review of the black-box warning for droperidol
Jackson et al.
Am J Health Syst Pharm 2007;64:1174-1186.
ABSTRACT
| FULL TEXT
Prevention of Postoperative Nausea and Vomiting
Wilhelm et al.
The Annals of Pharmacotherapy 2007;41:68-78.
ABSTRACT
| FULL TEXT
Are newer, more expensive pharmacotherapy options associated with superior symptom control compared to less costly agents used in a collaborative practice setting?
Weschules et al.
AM J HOSP PALLIAT CARE 2006;23:135-149.
ABSTRACT
Evidence-based management of postoperative nausea and vomiting: a review: [Le traitement des nausees et des vomissements postoperatoires fonde sur des donnees probantes : une revue]
Habib and Gan
Canadian J. Anesthesia 2004;51:326-341.
ABSTRACT
| FULL TEXT
Consensus Guidelines for Managing Postoperative Nausea and Vomiting
Gan et al.
Anesth. Analg. 2003;97:62-71.
ABSTRACT
| FULL TEXT
A Comparison of Dexamethasone, Ondansetron, and Dexamethasone plus Ondansetron as Prophylactic Antiemetic and Antipruritic Therapy in Patients Receiving Intrathecal Morphine for Major Orthopedic Surgery
Szarvas et al.
Anesth. Analg. 2003;97:259-263.
ABSTRACT
| FULL TEXT
|
