Kothari S N, Boyd W C, Bottcher M L, Lambert P J
Department of Surgery, Gundersen Lutheran, 1836 South Avenue, La Crosse, WI 54601, USA.
Surg Endosc. 2000 Oct;14(10):926-9. doi: 10.1007/s004640080055.
The prophylactic administration of dimenhydrinate (Dramamine) is as effective as the use of ondansetron (Zofran) in preventing postoperative nausea and vomiting (PONV) in patients undergoing elective laparoscopic cholecystectomy. A prospective double-blind randomized study was performed in a tertiary care referral center.
For this study, 128 American Society of Anesthesiology (ASA) physical statuses I, II, and III patients were randomly assigned to receive either ondansetron 4 mg intravenously (IV) at $17 per dose (group 1) or dimenhydrinate 50 mg IV at $2.50 per dose (group 2) before induction of anesthesia. The end points evaluated were frequency of PONV, need for rescue antiemetics, need for overnight hospitalization secondary to persistent nausea and vomiting, and frequency PONV 24 h after discharge.
Chi-square tests and student's t-test were used to determine the significance of differences among groups. Of the 128 patients enrolled in this study, 20 were excluded: 15 patients received an additional antiemetic preoperative; 4 were converted to open cholecystectomies; and 1 procedure was aborted due to carcinomatosis. Of the 108 remaining participants, 50 received ondansetron (group 1) and 58 received dimenhydrinate (group 2). Both groups were well matched for demographics including gender, ASA class, and history of motion sickness. The need for rescue antiemetics occurred in 34% of group 1 and 29% of Group 2 (p = 0.376), postoperative vomiting in 6% of group 1 and 12% of group 2 (p = 0.228), and postoperative nausea in 42% of group 1 and 34% of group 2 (p = 0.422). One group 1 patient and two group 2 patients required overnight hospitalization for persistent nausea, a difference that was not significant. Rates of PONV 24 h after discharge were similar between groups 1 and 2 (10% vs 14%, p = 0.397 and 2% vs 5%, p = 0.375, respectively).
Prophylactic administration of dimenhydrinate is as effective as the use of ondansetron in preventing PONV in patients undergoing elective laparoscopic cholecystectomy. Dimenhydrinate is the preferred drug because it is less expensive. With more than 500, 000 laparoscopic cholecystectomies performed in the United States each year, the potential drug cost savings from the prophylactic administration of dimenhydrinate instead of ondansetron exceed $7.25 million per year.
在择期腹腔镜胆囊切除术患者中，预防性给予茶苯海明（乘晕宁）在预防术后恶心呕吐（PONV）方面与使用昂丹司琼（枢复宁）同样有效。在一家三级医疗转诊中心进行了一项前瞻性双盲随机研究。
在本研究中，128例美国麻醉医师协会（ASA）身体状况为I、II和III级的患者被随机分配，在麻醉诱导前，一组静脉注射4毫克昂丹司琼（每剂17美元）（第1组），另一组静脉注射50毫克茶苯海明（每剂2.50美元）（第2组）。评估的终点包括PONV的发生率、使用补救性止吐药的必要性、因持续性恶心呕吐而需要过夜住院的情况以及出院后24小时PONV的发生率。
采用卡方检验和学生t检验来确定组间差异的显著性。在本研究纳入的128例患者中，排除了20例：15例患者术前额外使用了止吐药；4例转为开腹胆囊切除术；1例手术因癌转移而中止。在其余108名参与者中，50例接受昂丹司琼（第1组），58例接受茶苯海明（第2组）。两组在人口统计学特征（包括性别、ASA分级和晕动病史）方面匹配良好。第1组34%的患者和第2组29%的患者需要使用补救性止吐药（p = 0.376），第1组6%的患者和第2组12%的患者术后呕吐（p = 0.228），第1组42%的患者和第2组34%的患者术后恶心（p = 0.422）。第1组有1例患者和第2组有2例患者因持续性恶心需要过夜住院，差异无统计学意义。第1组和第2组出院后24小时PONV的发生率相似（分别为10%对14%，p = 0.397；2%对5%，p = 0.375）。
在择期腹腔镜胆囊切除术患者中，预防性给予茶苯海明在预防PONV方面与使用昂丹司琼同样有效。茶苯海明是首选药物，因为它更便宜。在美国，每年进行超过50万例腹腔镜胆囊切除术，预防性使用茶苯海明而非昂丹司琼每年可节省超过725万美元的潜在药物费用。
