Yonsei Med J.  2010 Jan;51(1):88-92. 10.3349/ymj.2010.51.1.88.

Comparison of Azasetron and Ondansetron for Preventing Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery

• Yun MJ
• Kim YH
• Kim AR

• KMID: 1779611
• DOI: http://doi.org/10.3349/ymj.2010.51.1.88

Abstract

PURPOSE
We compared the prophylactic effects of intravenously administered azasetron (10 mg) and ondansetron (8 mg) on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia. MATERIALS AND METHODS: We studied 98 ASA physical status I or II 20-65 years old, female patients, in this prospective, randomized, double blind study. Patients were randomly divided into two groups and received ondansetron 8 mg (group O) or azasetron 10 mg (group A) 5 min before the end of surgery. The incidence of PONV, Visual Analogue Scale (VAS) for pain, need for rescue antiemetic and analgesics, and adverse effects were checked at 1, 6, 12, 24, and 48 h postoperatively. RESULTS: The overall incidence of PONV was 65% in group O and 49% in group A. The incidence of PONV was significantly higher in group O than in group A at 12-24 h postoperatively (nausea; 24% vs. 45%, p = 0.035, vomiting; 2% vs. 18%, p = 0.008), but there were no significant differences at 0-1, 1-6, 6-12 or 24-48 h. CONCLUSION: In conclusion, azasetron (10 mg) produced same incidence of PONV as ondansetron (8 mg) in patients undergoing general anesthesia for gynecological laparoscopic surgery. Azasetron was more effective, in the intermediate post-operative period, between 12 and 24 h.

Keyword

Azasetron; gynecologic surgical procedures; ondansetron; postoperative nausea and vomiting; prophylaxis

MeSH Terms

Adult
Aged
Bicyclo Compounds, Heterocyclic/*therapeutic use
Female
Gynecologic Surgical Procedures/*adverse effects
Humans
Middle Aged
Ondansetron/*therapeutic use
Oxazines/*therapeutic use
Postoperative Nausea and Vomiting/*prevention & control
Serotonin Antagonists/*therapeutic use
Treatment Outcome
Young Adult

Reference

1. Gan TJ. Postoperative nausea and vomiting--can it be eliminated? JAMA. 2002. 287:1233–1236.

2. Ismail S. Practice of use of antiemetic in patients for laparoscopic gynaecological surgery and its impact on the early (1st two hrs) postoperative period. J Pak Med Assoc. 2008. 58:203–205.

3. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003. 97:62–71.

4. White PF, Watcha MF. Postoperative nausea and vomiting: prophylaxis versus treatment. Anesth Analg. 1999. 89:1337–1339.

5. Tsukagoshi S. [Pharmacokinetics of azasetron (Serotone), a selective 5-HT3 receptor antagonist.]. Gan To Kagaku Ryoho. 1999. 26:1001–1008.

6. Haga K, Inaba K, Shoji H, Morimoto Y, Fukuda T, Setoguchi M. The effects of orally administered Y-25130, a selective serotonin3-receptor antagonist, on chemotherapeutic agent-induced emesis. Jpn J Pharmacol. 1993. 63:377–383.

7. Sakamori M, Takehara S, Setoguchi M. [High affinity binding of Y-25130 for serotonin 3 receptor.]. Nippon Yakurigaku Zasshi. 1992. 100:137–142.

8. Hayakawa T, Sato M, Konaka M, Makino A, Hirohata T, Totsu S, et al. [Comparison of ramosetron and azasetron for prevention of acute and delayed cisplatin-induced emesis in lung cancer patients.]. Gan To Kagaku Ryoho. 2006. 33:633–638.

9. Kimura E, Niimi S, Watanabe A, Tanaka T. [Clinical effect of two azasetron treatment methods against nausea and vomiting induced by anticancer drugs including CDDP.]. Gan To Kagaku Ryoho. 1997. 24:855–859.

10. Bhatnagar S, Gupta D, Mishra S, Srikanti M, Singh M, Arora R. Preemptive antiemesis in patients undergoing modified radical mastectomy: oral granisetron versus oral ondansetron in a double-blind, randomized, controlled study. J Clin Anesth. 2007. 19:512–516.

11. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999. 91:693–700.

12. Krobbuaban B, Pitakpol S, Diregpoke S. Ondansetron vs. metoclopramide for the prevention of nausea and vomiting after gynecologic surgery. J Med Assoc Thai. 2008. 91:669–674.

13. Sandhu T, Tanvatcharaphan P, Cheunjongkolkul V. Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy: a prospective double-blind randomized study. Asian J Surg. 2008. 31:50–54.

14. Oksuz H, Zencirci B, Ezberci M. Comparison of the effectiveness of metoclopramide, ondansetron, and granisetron on the prevention of nausea and vomiting after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2007. 17:803–808.

15. Diemunsch P, Gan TJ, Philip BK, Girao MJ, Eberhart L, Irwin MG, et al. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery. Br J Anaesth. 2007. 99:202–211.

16. Lee Y, Wang PK, Lai HY, Yang YL, Chu CC, Wang JJ. Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting. Can J Anaesth. 2007. 54:349–354.

17. Gan TJ. Selective serotonin 5-HT3 receptor antagonists for postoperative nausea and vomiting: are they all the same? CNS Drugs. 2005. 19:225–238.

18. Kovac AL. Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists. J Clin Anesth. 2006. 18:304–318.

19. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth. 2004. 51:326–341.

20. Tramér MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997. 87:1277–1289.

21. Fukuda T, Setoguchi M, Inaba K, Shoji H, Tahara T. The antiemetic profile of Y-25130, a new selective 5-HT3 receptor antagonist. Eur J Pharmacol. 1991. 196:299–305.

22. Ozaki A, Sukamoto T. Improvement of cisplatin-induced emesis and delayed gastric emptying by KB-R6933, a novel 5-HT3 receptor antagonist. Gen Pharmacol. 1999. 33:283–288.

23. Odani N, Haga K, Setoguchi M. [Effect of Y-25130 on gastric motility in anesthetized rats.]. Nippon Yakurigaku Zasshi. 1993. 101:17–26.

24. Ho ST, Wang JJ, Liu HS, Hu OY, Tzeng JI, Liaw WJ. Comparison of PCA nalbuphine and morphine in Chinese gynecologic patients. Acta Anaesthesiol Sin. 1998. 36:65–70.

25. Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand. 2001. 45:795–804.

26. Wu O, Belo SE, Koutsoukos G. Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy. Can J Anaesth. 2000. 47:529–536.

27. Goll V, Akça O, Greif R, Freitag H, Arkiliç CF, Scheck T, et al. Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg. 2001. 92:112–117.

28. Larijani GE, Gratz I, Afshar M, Minassian S. Treatment of postoperative nausea and vomiting with ondansetron: a randomized, double-blind comparison with placebo. Anesth Analg. 1991. 73:246–249.