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3 - Comparison of the effects of granisetron and ondansetron on postoperative nausea and vomiting in supratentorial tumor patients using steroids
Oylum Selçuk, İnci Paksoy, Hacer Şebnem Türk, Faruk Seçkin Yücesoy, Enis Selçuk, Güneri Atalan, Sibel Oba
Objective: Postoperative nausea and vomiting (PONV) delays patient discharge and increases recovery room stays and recovery time. Furthermore, it increases the bleeding risk by causing increased intracranial pressure after craniotomy. The aim of this study was to compare the efficacy of steroids or steroids combined with ondansetron and granisetron in patients undergoing intracranial surgery.
Methods: The study was conducted on the patients undergoing supratentorial tumor surgery in the neurosurgery unit. 90 patients, classified as ASA physical status I and II, aged between 17-70 were included in this study. The study was planned as a prospective, randomized, double-blinded study. All the patients were medicated with 4 mg dexamethasone intravenously every 6 hours for the postoperative 24 hours. All patients had general anesthesia. Dura mater was turned off at the end of the surgery, and the patients were divided into 3 groups. Group 1 was treated with saline, Group 2 was treated with 8 mg ondansetron, and Group 3 was treated with 8 mg granisetron. Durations of operation and anesthesia, verbal destructive scale values for nausea at the postoperative 0th, 2nd, 4th, 6th, 8th, 12th, 16th, 24th hours, existence of vomiting, use of antiemetics, and side effects were collected.
Results: The nausea score distributions of Group 1, Group 2 and Group 3 between 0th to 10th hour were significantly different (p=0.0001). Nausea scores in Group 1 were significantly higher than Groups 2 and 3, whereas the difference between Group 1, Group 2 and Group 3 was found statistically insignificant between 12th to 24th hours. The nausea score distributions of the control group for the first 6 hours, ondansetron group for the first 4 hours and granisetron group for the first hour were significantly higher when compared to the other times.
The existence of vomiting in Group 1, Group 2 and Group 3 was significantly different between 0th to 10th hour (p=0.0001). The existence of vomiting in Group 1 was significantly higher than Group 2 and Group 3. But there was no significant difference between the groups in terms of existence of vomiting between 12th to 24th hours. The existence of vomiting in control group for the first 4 hours and in the ondansetron group for the first 2 hours were significantly higher than the other times, whereas no vomiting was observed in granisetron group.
The distribution of the need for antiemetic use between Group 1, Group 2 and Group 3 was found to be significantly different (p=0.02). The need for antiemetic use in Group 1 was significantly higher from that of Groups 2 and 3. No side effects were observed in any group.
Discussion: The results of our study showed that the antiemetic efficacy of dexamethasone alone was not enough for patients underwent supratentorial tumor surgery but it was effective for prevention of PONV when combined with ondansetron and granisetron. Although less nausea and vomiting has been observed in patients medicated with granisetron, the efficacy of ondansetron and granisetron was similar for preventing PONV.
Keywords: Postoperative nausea and vomiting, granisetron, ondansetron
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