Laparoskopik kolesistektomi sonrası postoperatif bulantı ve kusmanın önlenmesinde
tropisetron ve palonosetron’un karşılaştırılması: Randomize, çift-kör çalışma
Amaç: Postoperatif bulantı-kusma (POBK) anestezi sonrası en sık ortaya çıkan yan etkilerden biridir. POBK hastanın ameliyat sonrası derlenmesini ve hastanede kalış süresini uzatır. Bu çalışmada, intraoperatif uygulanan tropisetron ve palonosetronun, laparoskopik kolesistektomi sonrası postoperatif bulantı kusma üzerine etkilerinin karşılaştırılması amaçlandı. Yöntemler: Laparoskopik kolesistektomi planlanan, ASA I-II grubu, 18-65 yaş arası 142 hasta çalışmaya dahil edildi. Endotrakeal entübasyon sonrası iv yoldan Palonosetron Grubuna (Grup P) 0.075 mg palonosetron, Tropisetron Grubuna (Grup T) iv 5 mg tropisetron verildi. Hastaların postoperatif 0-72 saatlik zaman diliminde bulantı-kusma skorları, antiemetik kullanımları ve VAS skorları kaydedildi. Bulgular: Vakaların postoperatif 0-24 ve 48-72 saatlik dönemdeki bulantı-kusma skorları arasında gruplar arasında istatistiksel fark bulunmazken (p > 0.05), 24-48 saatlik dönemde ise Grup P’de, Grup T’ye göre bulantı-kusma skorları daha düşük bulundu (p < 0.024) (Tablo 3). Postoperatif antiemetik kullanımı açısından 72 saatteki her bir dönemde gruplar arasında fark yoktu (p > 0.05). 72 saatlik toplam ek antiemetik tüketimi ise Grup T’de, Grup P’ye göre istatistiksel olarak anlamlı yüksek bulundu (p = 0.025) (Tablo 4). Sonuç: POBK profilaksisinde antiemetik olarak kullanılan palonosetron, postoperatif 24-48 saatler arasında POBK şiddet skorunu ve toplam postoperatif 72 saatteki ek antiemetik ihtiyacını tropisetrona göre daha fazla azaltmıştır.
Comparison of palonosetron and tropisetron used for postoperative nausea and vomiting prophylaxis after laparoscopic cholecystectomy: A Randomized, double blinded study
Objective: Postoperative nausea-vomiting (PONV) is one of the most common side effects after anesthesia. PONV extends the duration of hospital stay and recovery time of the patient after the surgery. In this study, we compared the effects of tropisetron on palonosetron on postoperative nausea and vomiting after laparoscopic cholecystectomy. Methods: After endotracheal intubation, Palonosetron Group (Group P) received iv 0.075 mg of palonosetron and Tropisetron Group (Group T) received iv 5 mg of tropisetron. VAS scores, antiemetic use and nausea-vomiting scores were recorded in 0-72 hours interval. Results: In the 0-24 and 48-72 hour intervals, there were no statistical difference between the groups with respect to nausea-vomiting scores, but, in the 24-48 hour interval, nausea-vomiting score was lower in Group P than Group T (p < 0.024) (Table 3). There was no statistical difference in all 72 hour intervals with respect to antiemetic use (p > 0.05). 72 hours total antiemetic use was statisticaly higher in Group T than Group P (p = 0.025) (Tablo 4). Conclusion: For PONV prophylaxis, palonosetron decreased the PONV score and antiemetic need more than tropisetron in the first 72 hours.
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- 1. Watcha MF, White PF. Postoperative nausea and vomiting.
Its etiology, treatment, and prevention. Anesthesiology
1992;77:162-84.
- 2. Kaya Z, Kaya S, Ölmez G. Granisetron-deksametazon kombinasyonunun
jinekolojik girişimlerde postoperatif bulantı
ve kusma üzerine etkileri. Dicle Tıp Derg 2010;37:109-14.
- 3. Menteş SE, Okur N, Günel ME, et al. Siklik kusma sendromu.
Dicle Tıp Derg 2008;35;201-3.
- 4. Naguib M, Bakry AKE, Khoshim MHB, et al. Prophylactic
antiemetic therapy with ondansetron, tropisetron, granisetron,
and metoclopramide in patients undergoing laparoscopic
cholecystectomy: a randomized, double-blind comparison
with placebo. Can J Anaesth 1996;43:226-31.
- 5. Fujii Y, Saitoh Y, Tanaka H, et al. Ramosetron vs granisetron
for the prevention of postoperative nausea and vomiting
after laparoscopic cholecystectomy. Can J Anaesth
1999;46:991–3.
- 6. Anthony L. Kovac. Prevention and Treatment of Postoperative
Nausea and Vomiting. Drugs 2000;59:213–243.
- 7. Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical
efficacy of 5-hydroxytryptamine type 3 receptor antagonists
for postoperative nausea and vomiting. Curr Opin
Anaesthesiol 2006;19:606–11.
- 8. Argiriadou H, Papaziogas B, Pavlidis T, et al. Tropisetron
vs ondansetron for prevention of postoperative nausea and
vomiting after laparoscopic cholecystectomy: a randomized
double-blind, placebo-controlled study. Surg Endosc
2002;16:1087-90.
- 9. Wang JJ, Ho ST, Uen YH, et al. Small-dose dexamethasone
reduces nausea and vomiting after laparoscopic cholecystectomy:
a comparison of tropisetron with saline. Anesth
Analg 2002;95:229-32.
- 10. Muchatuta NA, Paech MJ. Management of postoperative
nausea and vomiting: focus on palonosetron. Ther Clin
Risk Manag 2009;5:21-34.
- 11. Candiotti KA, Kovac AL, Melson TI, et al. A randomized,
double-blind study to evaluate the efficacy and safety of
three different doses of palonosetron versus placebo for
preventing postoperative nausea and vomiting. Anesth
Analg 2008;107:445-51.
- 12. Almarakbi WA, Kaki AM. Addition of dexmedetomidine to
bupivacaine in transversus abdominis plane block potentiates
post-operative pain relief among abdominal hysterectomy
patients: A prospective randomized controlled trial.
Saudi J Anaesth 2014;8:161-6.
- 13. Madenoglu H, Aksu R, Bicer C, et al. The effect of palonosetron
on postoperative nausea and vomiting in supratentorial
craniotomy patients. Turk J Med Sci 2012;42:1241-46.
- 14. Moon YE, Joo J, Kim JE, Lee Y. Anti-emetic effect of
ondansetron and palonosetron in thyroidectomy: a prospective,
randomized, double-blind study. Br J Anaesth
2012;108:417-22.
- 15. Taylor E, Feinstein R, White PF, Soper N. Anesthesia for
laparoscopic cholecystectomy. Is nitrous oxide contraindicated?
Anesthesiology 1992;76:541-3.
- 16. Tiippana E, Hamunen K, Kontinen V, Kalso E. The effect
of paracetamol and tropisetron on pain: experimental studies
and a review of published data. Basic Clin Pharmacol
Toxicol 2013;112:124-31.
- 17. Stratz C, Bhatia HS, Akundi RS, et al. The anti-inflammatory
effects of the 5-HT3
receptor antagonist tropisetron
are mediated by the inhibition of p38 MAPK activation
in primary human monocytes. Int Immunopharmacol
2012;13:398-402