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Systematic Review of Ondansetron for the Prevention and Treatment of Postoperative Nausea and Vomiting in Adults

Objectives To determine the efficacy and safety of ondansetron for the prevention and treatment of postoperative nausea and vomiting (PONV) in adults. Design Systematic review of published double-blind randomised controlled trials. Data sources Twenty seven trials from 1990 to July 1998 retrieved from a systematic literature search (Medline, Cinahl, Embase, Cochrane Library, reference lists, hand searching of anaesthetic journals, & provided manufacturer information); restricted to English language. Main outcome measures Estimation of efficacy (incidence of complete absence of nausea or other outcome measure as defined by the authors) at 24 hours. Results Seven double-blind randomised controlled trials with 1,623 patients studied intravenous ondansetron 1mg, 4mg, or 8mg for the treatment of postoperative nausea and vomiting (PONV). Four mg, compared with metoclopramide 10mg, produced higher patient satisfaction scores and an increased incidence of freedom from nausea at 24 hours. Further studies are required to compare the safety, efficacy and dose response with other anti-emetics at 24 hours. Twenty double-blind randomised controlled trials with 4,364 patients studied intravenous and oral administration of ondansetron 1mg, 4mg, and 8mg for the prevention of postoperative nausea and vomiting. There appears to be no significant difference between droperidol (0.625mg, 1mg or 1.25 mg) IV and ondansetron 4mg in efficacy and incidence of side effects. Compared with metoclopramide, ondansetron produced less nausea but the incidence of vomiting was the same at 24 hours. Conclusions Further PONV could be prevented with ondansetron 4mg compared with placebo and metoclopramide 10mg. Further studies are required to compare ondansetron with other anti-emetics for the treatment of PONV. For prophylaxis of PONV ondansetron 4mg appears to be equal to low dose droperidol in efficacy and the incidence of side effects, and superior to metoclopramide. Ondansetron should perhaps be limited to second line treatment in view of patient satisfaction, efficacy and cost when compared with droperidol.