Oral Clonidine in reduction of Postoperative nausea and vomiting after laparoscopic cholecystectomy: Double blind placebo controlled trail
Keywords:
Clonidine, laparoscopic cholecystectomy, nausea, vomitingAbstract
Background The common adverse effects of laparoscopic cholecystectomy include nausea and vomiting. Surgical pneumoperitoneum can stimulate vagal response and induce the release of various emetogenic substances such as 5-hydroxytryptamine and acetylcholine. We hypothesized that oral Clonidine administered pre-operatively reduces the post operative nausea and vomiting following laparoscopic cholecystectomy.
Methodology In a randomized, double-blinded placebo controlled study, seventy patients undergoing laparoscopic cholecystectomy were assigned to receive either oral Pyridoxine (placebo) or oral Clonidine 200micrograms 20-30 minutes before conduction of general anaesthesia. We assessed post operative nausea and vomiting and compared its incidence following laparoscopic cholecystectomy with prophylactic use of oral Clonidine or placebo. We also found out the requirements of rescue anti-emetic medication (Ondansetron and Promethazine) for post operative nausea and vomiting after prophylactic use of oral Clonidine or Placebo.
Results Three patients in Clonidine group and 12 patients in Placebo group vomited in first two hours. Likewise, 11 and 22 patients vomited in Clonidine and Placebo group over 24 hours respectively. In group Clonidine, 18 patients had nausea in first two hours and 20 patients had nausea over 24 hours. In group Placebo, 33 patients developed nausea in first two hours and over 24 hours. Ten patients in Clonidine group and 19 patients in Placebo group required Ondansetron as rescue antiemetics over 24 hours.
Conclusion Oral Clonidine given pre-operative to patients undergoing laparoscopic cholecystectomy decrease the incidence of post operative nausea and vomiting.
References
2. Koivuranta MK, Laraa E, Ryhanen PT. Antiemetic efficacy of prophylactic ondansetron in laparoscopic cholecystectomy. A randomized, double-blinded, placebo-controlled trial. Anaesthesia 1996;51:52-5.
3. Thune A, Appelgren L, Haglind E. Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Eur J Surg 1995;161:265-8.
4. Hill RP, Lubarsky DA, Phillips-Bute B, Fortney JT, Creed MR, Glass PS et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol or placebo. Anesthesiology 2000;92:958-7.
5. Begos DG, Modlin IM. Laparoscopic cholecystectomy: from gimmick to gold standard. J Clin Gastroenterol 1994;19:325-30.
6. Yotsui T. Clonidine premedication prevents sympathetic hyperactivity but does not prevent hypothalamo-pituitary-adrenocortical responses in patients undergoing laparoscopic cholecystectomy. J Anesth 2001;15:78-82.
7. Javaherfroosh F, Pipelzadeh MR, Namazi M. Clonidine reduces post operative nausea and vomiting in laparoscopic gyanecology surgery. Pak J Med Sci 2009;25:782-5.
8. Taheri A, Javadimanesh MA, Ashraf H. The effect of oral clonidine premedication on nausea and vomiting after ear surgery. Middle East J. Anesthesiol 2010;20:691-4.
9. Oddby-Muhrbeck E, Eksborg S, Bergendhal HT, Muhrbeck O, Lonnqvist PA. The effect of clonidine in postoperative nausea and vomiting in breast cancer surgery. Anesthesiology 2002;96:1109-14.
10. Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS et al . Society for Ambulatory Anesthesia Guidelines for the management of Postoperative Nausea and Vomiting. Anesth Analg 2007;105:1615-28.
11. Ramsay MA, Savege TM, Simson BR, Goodwin R. Controlled Sedation with Alphaxalone-Alphadolone. Br Med J 1974;2:656-9.
12. Mikawa K, Nishina K, Maekawa N, Asano M, Obara H. Oral clonidine premedication reduces vomiting in children after strabismus surgery. Can J Anaesth 1995;42:977-81.
13. Handa F, Fujji Y. The efficacy of oral Clonidine premedication in the prevention of postoperative vomiting in children following strabismus surgery. Paediatr. Anesthesia 2001;11:71-4.
14. Anti-Hypertensive drugs. In: Stoelting RK, Hillier SC. Pharmacology & Physiology in Anesthetic Practice. 4th ed. Philadephia: Lippincot Wiliams; 2007 p 338-51.
15. Wallenborn J, Gelbrich G, Bulst D, Behrends K, Wallenborn, Rohrbach A et al. Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: Randomised double blind multicentre trial. BMJ 2006;333:324-8.
16. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012;6:172-87.
17. Bosch JE van den, Moons KGM, Bonsel GJ, Kalkman CJ. Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting? Anaesth Analg 2005;100:1525-32.
18. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004;350:2441-51.
19. Tramer MR, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. Br J Anaesth 1999;82:379-86.
20. Kerger KH, Mascha E, Steinbrecher B, Frietsch T, Radke OC, Stoecklein K et al. Routine Use of Nasogastric Tubes Does Not Reduce Postoperative Nausea and Vomiting. Anesth Analg 2009;109:768-73.
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
