POSTOPERATİF BULANTI-KUSMANIN ÖNLENMESİNDE TROPİSETRON VE METOKLOPRAMİDİN ETKİLERİNİN KARŞILAŞTIRILMASI

Abstract

Özet : Çalışmamızda genel anestezi altında tiroidektomi operasyonu geçirecek hastalarda (n=40) postoperatif bulantı-kusma (POBK)’nın önlenmesinde tropisetronun etkinliği metoklopramid ile karşılaştırıldı. Randomize çift-kör çalışmamızda; American Society of Anesthesiologists (ASA) I-II sınıflandırmasına göre 18- 70 yaş arası 40 hasta 20’şer kişilik iki gruba ayrıldı. Metoklopramid grubu (Grup M)’na indüksiyondan önce iv 10 mg metoklopramid ve tropisetron grubu (Grup T)’na iv 2 mg tropisetron verildi. Bütün hastalara standart genel anestezi uygulandı. İlaçların antiemetik etkileri ve yan etkileri, her iki gruptaki antiemetik gereksinimi 24 saat boyunca değerlendirildi. Grupların bulantı-kusma skoru açısından karşılaştırılmasında Grup T’de Grup M’ye göre bulantı-kusma skoru sıfır olan hasta sayısı istatistiksel olarak anlamlı şekilde yüksekti (p=0.027), diğer skorlar için gruplar arası istatistiksel olarak anlamlı fark bulunmadı. Bulantıkusma görülme sıklığı her iki grupta benzerdi. Yan etkiler açısından gruplar arası istatistiksel olarak anlamlı fark belirlenemedi. Tiroidektomi geçiren hastalarda POBK’yı önlemede genel anestezi indüksiyonu öncesi 2 mg iv tropisetron uygulandığında 24 saat boyunca POBK riskinin metoklopramide göre daha az olduğu, dolayısıyla tropisetronun uzun etkili bir antiemetik ajan olarak POBK’nın önlenmesinde kullanılabileceği sonucuna varıldı.

Keywords

• Postoperatif bulantı-kusma (POBK), tropisetron, metoklopramid, tiroidektomi

Comparison of the Effects of Tropisetron and Metoclopramid in Prevention of Postoperative Nausea and Vomiting

Abstract

Summary: This study compared the efficacy of tropisetrone and metoclopramide in preventing postoperative nausea-vomiting (PONV) of the patients (n=40) who underwent thyroidectomy under general anesthesia. In our randomized double-blind study, 40 patients (between the age 18-70 years) who were classified in American Society of Anesthesiologists (ASA) I and II groups were classified into two groups, with 20 patients in each. Before induction, 10 mg metoclopramide was administered to metoclopramide group (Group M), while 2 mg tropisetrone was administered to tropisetrone group (Group T) intravenously. All patients had standard general anesthesia. Antiemetic and side effects of the drugs, and the antiemetic requirements of the patients in both groups were followed up for 24 hours. When postoperative nausea-vomiting scores of the groups were compared, the number of the patients with a score of 0 was statistically significantly higher in Group M than in Group T (p=0.027), and no differences were detected among the other scores. The frequency of nausea-vomiting was almost the same in both groups. There were no statistically significant differences between the groups for side effects. The results of this study indicated that 2 mg intravenous tropisetron application before induction of general anesthesia in thyroidectomy patients prevents postoperative nausea-vomiting better than metoclopramide in 24-hour period. In conclusion, tropisetrone may be used as a long-lasting antiemetic drug to prevent postoperative nausea-vomiting

Keywords

• Postoperative nausea and vomiting (PONV), tropisetron, metoclopramide, thyroidectomy

References

1. 1. Stadler M, Bardiau F, Seidel L et al. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology 2003;98:46-52.
2. 2. Koivuranta M, Laara E, Snare L, et al. A survey of postoperative nausea and vomiting. Anaesthesia 1997;52:443-449.
3. 3. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006;102:1884–1898.
4. 4. Watcha MF and White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology 1992;77:162- 184.
5. 5. Ku CM, Ong BC. Postoperative nausea and vomiting: a review of current literature. Singapore Med J 2003;44:366-374.
6. 6. American Society of Health System Pharmacists. Prevention and treatment of postoperative nausea and vomiting. Am J Health-Syst Pharm 2005;62:1247-1260.
7. 7. Alon E, Buchser E, Herrera E, et al. Tropisetron for treating established postoperative nausea and vomiting: a randomized, doublelind, placebo-controlled study. Anesth Analg 1998;86:617-623.
8. 8. Zomers PJW, Langerberg CJM, de Brujin KM. Tropisetron for postoperative nausea and vomiting in patients after gynaecological surgery. Br J Anaesth 1993; 1: 677-80.

9. 9. Kranke P, Eberhart LH, Apfel CC, et al. Tropisetron for prevention of postoperative nausea and vomiting: a quantitative systematic review. Anaesthesist 2002;51:805 -814.
10. 10. de Bruijn KM. The development of tropisetron in its clinical perspective. Ann Oncol 1993;4 (Suppl 3):19-23.
11. 11. Kutz K. Pharmacology, toxicology and human pharmacokinetics of tropisetron. Ann Oncol 1993;4 (Suppl 3):15-18.
12. 12. Andrews PL. Physiology of nausea and vomiting. Br J Anaesth 1992;69 (Suppl 1):2- 19.
13. 13. Jokela R, Koivuranta M. Tropisetron or droperidol in the prevention of postoperative nausea and vomiting. A comparative, randomised, double-blind study in women undergoing laparoscopic cholecystectomy. Acta Anaesth Scand 1999;43:645-650.
14. 14. Kaufmann MA, Rosow C, Schnieper P, et al. Prophylactic antiemetic therapy with patientcontrolled analgesia: a double-blind, placebo -controlled comparison of droperidol, metoclopramide, and tropisetron. Anesth Analg 1994;78:988-994.
15. 15. 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;95:229–232.
16. 16. Capouet V, De Pauw C, Vernet B, et al. Single dose i.v. tropisetron in the prevention of postoperative nausea and vomiting after gynaecological surgery. Br J Anaesth 1996;76:54-60.
17. 17. Alon E, Kocian R, Nett PC, et al. Tropisetron for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery Anesth Analg 1996;82:338-341.
18. 18. Akın A, Esmaoglu A, Gunes I, et al. The effects of the prophylactic tropisetronpropofol combination on postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. Mt Sinai J Med 2006;73:560-563.
19. 19. Korttila K. The study of postoperative nausea and vomiting. Br J Anaesth 1992;69 (Suppl 1):20S-23S.
20. 20. Madenoglu H, Yıldız K, Doğru K, et al. Randomized, double-blinded comparison of tropisetron and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. J Neurosurg Anesthesiol 2003;15:82–86.