A prospective cohort study on the effectiveness of small dose of propofol compared to metoclopromide for prevention of postoperative nausea and vomiting after gynecologic surgery in Tikur Anbessa Specialaized hospital, from January 10 to march 10, 2018 GC.
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Date
2018-06
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Addis Ababa Universty
Abstract
Background: Post‐operative nausea and vomiting (PONV) is a common problem affecting 30%-70% of the patient within the first 24 to 48 hours after surgery. Although PONV often considered merely an unpleasant side effect it may result many unwanted and potentially serious outcomes and increases healthcare expenditure. Propofol is an anesthetic agent used commonly for induction and maintenance. Recently its antiemetic activity at subhypnotic low dose makes it as one prophylactic medication for Postoperative Nausea and vomiting.
Objective: To compare the effectiveness of small dose of propofol with metoclopromide on prevention of postoperative nausea and vomiting after gynecologic surgery under general anesthesia at Tikur Anbessa Specialized Hospital.
Method: This institutional based prospective cohort study recruits 78 patients who underwent gynecologic surgery randomly. Chi Square test were used to compare the incidence of PONV and Manny Whitney test and independent t test used to compare median nausea score and mean total antiemetic consumption between groups respectively. Homogeneity of categorical independent variables between two groups analyzed using Chi Square. Bar chart and Box and Whisker plot were used to show the result between groups and statistical significance were seated at p value < 0.05 with a power of 80%.
Results: The comparison of data showed that during the first 6hr the incidence of postoperative nausea and vomiting were 41% in propofol group and 64.1% in metoclopromide group (p=0.041). The incidence of nausea alone have statistically significant higher association in metoclopromide than propofol group 64.1% versus 41% respectively (P =0.041) during the first 6hr but there were no statistically differences at 12 and 24 postoperative hours. The median nausea severity NRS score in the first 6 postoperative hours were lower 0 in propofol compared to 3 in metoclopromide group (p= 0.032). There were no statistically significant differences in median nausea severity NRS score at 12th and 24th postoperative time. The mean (SD) rescue antiemetic metoclopromide consumption over 24hrs in mg were 1.28±3.38 in propofol group compared to 1.78±3.89 in metoclopromide group which have no statistical difference (p=0.54).
Conclusion and Recommendation: Small dose propofol given at the end of surgery is more effective than metoclopromide but have no difference after 6 hours to reduce the incidence and severity of post operative nausea and vomiting after gynecologic surgery. Based on these we recommend use of low dose propofol is effective antiemetic than metoclopromide in the first 6 postoperative hours.
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Keywords
Post‐operative nausea and vomiting,small dose,surgery.