Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. A prospective randomized study of metoclopramide and transdermal hyoscine.

OBJECTIVE

To compare the antiemetic effects of metoclopramide and hyoscine in patients after laparoscopic cholecystectomy.

DESIGN

Prospective, randomised trial.

SETTING

University hospital, Sweden.

SUBJECTS

100 consecutive patients median age 49 years (range 21-79) of whom 9 were withdrawn after randomisation.

INTERVENTIONS

Patients were randomised to receive either four doses of metoclopramide 10 mg intravenously starting at the induction of anaesthesia (n = 44), or hyoscine transdermally through a patch placed behind the ear at 0600 h on the day of operation (n = 47).

MAIN OUTCOME MEASURES

The incidence of nausea and vomiting.

RESULTS

Metoclopramide was significantly more effective at preventing both nausea and vomiting (20/44 (45%) compared with 32/47 (68%), p < 0.05, and 10/44 (23%) compared with 21/47 (45%), p < 0.05). Women were significantly more likely to become nauseated than men (46/66 (70%) compared with 5/25 (20%), p < 0.001). Two patients in the metoclopramide group developed dizziness, and one patient in the hyoscine group had a disturbance of vision. About 20% in each group required additional antiemetic treatment. The median hospital stay in both groups for patients who did not develop complications was 2 days.

CONCLUSION

There was a high incidence of nausea and vomiting after laparoscopic cholecystectomy even after treatment with metoclopramide. Further measures are indicated, particularly for women.