Akademik Veri Yönetim Sistemi
Journal of International Medical Research, cilt.31, sa.4, ss.267-271, 2003 (SCI-Expanded)
We compared the antiemetic efficacy of tropisetron versus droperidol in women given tramadol after total hysterectomy. Forty patients were randomly allocated to group 1 (n = 20, tropisetron 0.05 mg/kg intravenously) or group 2 (n = 20, droperidol 15 μg/kg intravenously). Tramadol infusion (intravenously), for post-operative analgesia, was started at fascia closure. Incidences of post-operative nausea and vomiting, pain intensity, tramadol use, and the need for a rescue antiemetic (metoclopramide 10 mg) were recorded 0 h, 2 h, 6 h, 12 h, 24 h and 48 h post-operatively. Vomiting and nausea incidences were reported fewer in group 1 than in group 2, but statistical significance was only reached for vomiting incidence 6 h post-operation. Tropisetron seems to have better antiemetic properties than droperidol in patients receiving tramadol, because of the length of its duration of action. Further studies, investigating alternative ways of managing post-operative nausea and vomiting, and the use of tramadol for post-operative analgesia, are needed. Indications:Prevention of postoperative nausea and vomiting (PONV) in 22 patients. Patients:44 female inpatients were recruited, 22 in the Navoban and droperidol groups, respectively, and 40 were available for analysis. Navoban group: 20 patients aged 45.45 ± 1.37 years. Droperidol group: 20 patients aged 45.33 ± 1.31 years. 2 Navoban patients were excluded due to missing data, and 2 droperidol patients did not use PCA. TypeofStudy:The antiemetic efficacy of Navoban versus droperidol in women given tramadol as patient controlled analgesia (PCA), after total abdominal hysterectomy was studied. Comparative, double blind, randomized, controlled clinical study. DosageDuration:Single dose of 0.05 mg/kg diluted to 5 ml with 0.9 percent saline iv. ComparativeDrug:Droperidol was given at a single dose of 15 mcg/kg in 5 ml of 0.9 percent saline, iv. Results:Two patients in the Navoban group were excluded because of missing data, and two patients in the droperidol group did not want to use the PCA pump because of prolonged vomiting. No difference in pain scores or need for rescue antiemetic treatment was observed between the groups. Tramadol consumption was greater in Navoban group than in droperidol group, but this difference was not significant at any recorded time. Vomiting and nausea were reported less frequently in the Navoban group than in droperidol group, but this difference was only significant for the incidence of vomiting at 6 hours after the operation. No difference in sedation levels or any possible adverse events were noted. AdverseEffects:No adverse events occurred. AuthorsConclusions:In conclusion, because of its long duration of action, tropisetron seems to have better antiemetic properties than droperidol in patients receiving tramadol. Further studies, investigating better PONV management alternatives with the use of double or triple combination antiemetic therapy, in patients given tramadol for post-operative analgesia, are still needed. FreeText:Female inpatients undergoing elective total abdominal hysterectomy were premedicated with 5-10 mg diazepam orally, 1 hour before the operation. Patients were monitored for heart rate, non-invasive systemic blood pressure, peripheral oxygen saturation, end-tidal carbon dioxide and urine output. Anesthesia was induced with atropine, fentanyl, thiopental, and maintained with sevoflurane and nitrous oxide in oxygen. Tracheal intubation was facilitated with vecuronium and diclofenac sodium was administered as an adjunct analgesic. At the beginning of fascia closure, patients randomly received 0.05 mg/kg Navoban, diluted to 5 ml with 0.9 percent saline (group 1), or 15 mcg/kg droperidol in 5 ml of 0.9 percent saline (group 2), iv. Simultaneously, an infusion of tramadol, via a PCA device, was started: loading dose, 50 mg; background infusion, 5 mg/h; demand dose, 20 mg at 15 min intervals; and 4 hour-limit dose, 200 mg. The occurrence of nausea and vomiting, request for a rescue antiemetic, tramadol consumption, intensity of post-operative pain, level of sedation and any possible adverse events were recorded 0-hour (h), 2-h, 6-h, 12-h, 24-h and 48-h post-operatively. Metoclopramide was chosen as the rescue antiemetic drug and was given to patients who experienced vomiting or who requested treatment for nausea. A 4- point scale was used to score PONV (0=none; 1=nausea; 2=retching; 3=vomiting). The highest score of PONV was recorded in patients who experienced both nausea and vomiting. Pain intensity was also assessed by the patients. Antiemetic efficacy was measured by the incidence of nausea, vomiting, and use of rescue medication during the first 48 post-operative hours.