Department of Orthopaedic Surgery, West China Hospital, Sichuan University, 37#Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
Department of Orthopaedic surgery, The First Affiliated Hospital of Zhengzhou University, No.1 East of Jianshe Road, Zhengzhou, 450052, People's Republic of China.
BMC Pharmacol Toxicol. 2024 Jan 30;25(1):12. doi: 10.1186/s40360-024-00735-9.
Postoperative nausea and vomiting (PONV) after total joint arthroplasty is common and associated with delayed recovery. This study was performed to evaluate the efficacy of three different prophylactic regimens for PONV after total joint arthroplasty under general anesthesia.
Patients undergoing primary total hip or knee arthroplasty were randomized to Group A (ondansetron), Group B (10 mg dexamethasone plus ondansetron and mosapride), or Group C (three doses of 10 mg dexamethasone plus ondansetron and mosapride). The primary outcome was the total incidence of PONV during postoperative 48 h. The secondary outcomes were complete response, rescue antiemetic treatment, opioid consumption, time until first defecation, postoperative appetite score, satisfaction score, length of hospital stay, blood glucose level, and complications.
Patients in Group C experienced a lower incidence of total PONV (29.3%, p = 0.001) and a higher incidence of complete response (70.7%, p = 0.001) than did patients in Group A (51.9%, 48.2%, respectively). Patients in Group C also experienced a lower incidence of severe PONV (4.3%) than patients in Group A (25.9%, p<0.001) and B (20.4%, p<0.001). Moreover, less rescue antiemetic treatment (1.4 ± 0.5 mg Metoclopramide) and postoperative opioid consumption (1.8 ± 0.3 mg Oxycodone, 6.0 ± 1.0 mg Pethidine) was needed in Group C. Additionally, a shorter time until first defecation, shorter length of stay, and better postoperative appetite scores and satisfaction scores were detected in patients in Group C. A slight increase in the fasting blood glucose level was observed in Group C, and the complications were comparable among the groups.
Combined use of ondansetron, mosapride and three doses of dexamethasone can provide better antiemetic effectiveness, postoperative appetite, bowel function recovery, and pain relief than a single dose or ondansetron only.
The protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800015896, April 27, 2018).
全关节置换术后恶心和呕吐（PONV）很常见，并且与恢复延迟有关。本研究旨在评估三种不同预防方案对全麻下全关节置换术后 PONV 的疗效。
接受初次全髋关节或膝关节置换术的患者被随机分为 A 组（昂丹司琼）、B 组（10mg 地塞米松+昂丹司琼+莫沙必利）或 C 组（3 次 10mg 地塞米松+昂丹司琼+莫沙必利）。主要结局是术后 48 小时内 PONV 的总发生率。次要结局是完全缓解、解救性止吐治疗、阿片类药物消耗、首次排便时间、术后食欲评分、满意度评分、住院时间、血糖水平和并发症。
C 组患者总 PONV 发生率（29.3%，p=0.001）和完全缓解率（70.7%，p=0.001）均低于 A 组（51.9%，48.2%）。C 组患者严重 PONV 发生率（4.3%）也低于 A 组（25.9%，p<0.001）和 B 组（20.4%，p<0.001）。此外，C 组需要更少的解救性止吐治疗（1.4±0.5mg 胃复安）和术后阿片类药物消耗（1.8±0.3mg 羟考酮，6.0±1.0mg 哌替啶）。此外，C 组患者首次排便时间更短，住院时间更短，术后食欲和满意度评分更高。C 组患者空腹血糖水平略有升高，各组并发症相似。
与单次剂量或昂丹司琼单药治疗相比，昂丹司琼、莫沙必利和地塞米松三联用药可提供更好的止吐效果、术后食欲、肠道功能恢复和疼痛缓解。
该方案于 2018 年 4 月 27 日在中国临床试验注册中心（ChiCTR1800015896）注册。
