Antiemetic efficacy of granisetron and metoclopramide in children undergoing ophthalmic or ENT surgery.

PURPOSE

The purpose of this study was to compare the effectiveness of granisetron, metoclopramide and placebo in reducting the frequencies of retching and vomiting in children who had undergone strabismus repair and tonsillectomy with or without adenoidectomy.

METHODS

In a randomized, double-blind study, 70 healthy subjects, 4-10 yr of age, were given a single dose of either placebo (saline, n = 24), metoclopramide 0.25 mg.kg-1 (n = 23) granisetron 40 micrograms.kg-1 (n = 23) iv over two to five minutes after the induction of anaesthesia. All subjects received inhalation anaesthesia with sevoflurane and nitrous oxide in oxygen. Rescue antiemetics were administered if two or more episodes of vomiting occurred. Acetaminophen pr or pentazocine iv was given as needed for postoperative pain. All subjects remained in hospital for two days. During the first three and the next 21 hr after anaesthesia, the frequencies of retching and vomiting were recorded by nursing staff.

RESULTS

There was no difference among groups with regard to demographic characteristics, surgical procedures, anaesthetics administered, postoperative managements, or adverse effects. During 0-3 hr after anaesthesia, the frequencies of retching and vomiting were: placebo 62%, metoclopramide 22% and granisetron 13% (P < 0.05). The corresponding frequencies during 3-24 hr after anaesthesia were: placebo 50%, metoclopramide 39% and granisetron 13% (P < 0.05). Four children who had received placebo and three who had received metoclopramide required another rescue antiemetic.

CONCLUSION

Granisetron 40 micrograms.kg-1 is more effective than either metoclopramide or placebo in reducing the frequencies of postoperative retching and vomiting during the first 24 hr after anaesthesia in children who have undergone strabismus surgery and tonsillectomy with or without adenoidectomy.