Dr Goetz Gelbrich and colleagues from Germany evaluated whether treatments prevent postoperative nausea and vomiting.
The researchers assessed whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in than 8 mg dexamethasone alone.
The team conducted a 4-armed, parallel group, double blind, randomized controlled clinical trial.
The researchers included 4 clinics of a university hospital and 4 district hospitals.
There were 3140 patients who received balanced or regional anesthesia during surgery.
|Only 50 mg reduced late nausea and vomiting|
|British Medical Journal|
Main outcome measures were postoperative nausea and vomiting within 24 hours of surgery, and occurrence of adverse reactions.
The researchers found that incidences of postoperative nausea and vomiting were 23%, 21%, 17%, and 15% for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.
In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea.
The team noted that only 50 mg reduced late nausea and vomiting.
The most frequent adverse drug reactions were hypotension and tachycardia.
The researchers observed that the cumulative incidences were 9%, 11%, 13%, and 18% for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.
Dr Gelbrich's team concludes, “The addition of 50 mg metoclopramide to 8 mg dexamethasone is an effective, safe, and cheap way to prevent postoperative nausea and vomiting.”
“A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions.”