J Korean Pain Soc.  2004 Dec;17(2):222-227. 10.3344/jkps.2004.17.2.222.

The Effect of the Granisetron and Ramosetron on the Prevention of Postoperative Nausea and Vomiting during Intravenous Patient Controlled Analgesia with Fentanyl after Total Knee Replacement Surgery

• Hwang BM
• Yang HS
• Hahm KD
• Leem JG

• KMID: 2104859
• DOI: http://doi.org/10.3344/jkps.2004.17.2.222

Abstract

BACKGROUND
Nausea and vomiting are one of the most distressing side effects in patient controlled analgesia using opioids. Both granisetron and ramosetron, selective 5-hydroxytryptamine type 3 receptor antagonists, were studied for the prevention of the postoperative nausea and vomiting (PONV) that may occur during intravenous patient controlled analgesia (IV-PCA) using fentanyl and ketorolac. METHODS: Ninety patients receiving total knee replacement surgery under isoflurane anesthesia were randomly allocated to one of three groups. Each group was administered one of the aforementioned drugs mixed with their PCA solutions; saline, granisetron 3 mg or ramosetron 0.3 mg, respectively. The postoperative pain was controlled by IV-PCA, with fentanyl 20microgram/kg and ketorolac 3 mg/kg in normal saline (total volume; 100 ml, basal rate; 1.5 ml/h, volume of bolus doses; 1 ml, lockout interval; 10 min). The pain scores, frequencies of rescue analgesics requirement, incidence of vomiting, cumulated doses of fentanyl, incidence of severe nausea requiring additional antiemetics and the severity scores for nausea were checked up to second postoperative day by a blind observer. RESULTS: The severity score for postoperative nausea was low in the granisetron and ramosetron groups compared with saline control group (P < 0.05). There were no significant differences between the three groups in their pain scores, frequencies of rescue analgesics requirement, incidence of vomiting, cumulated doses of fentanyl and incidence of severe nausea requiring additional antiemetics. CONCLUSIONS: These results suggest that the incidence of severe PONV was not low, but the severity of postoperative nausea can be lowered by granisetron and ramosetron during IV-PCA with fentanyl and ketorolac.

Keyword

fentanyl; granisetron; nausea; patient-controlled analgesia; ramosetron; vomiting

MeSH Terms

Analgesia, Patient-Controlled*
Analgesics
Analgesics, Opioid
Anesthesia
Antiemetics
Arthroplasty, Replacement, Knee*
Fentanyl*
Granisetron*
Humans
Incidence
Isoflurane
Ketorolac
Nausea
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Postoperative Nausea and Vomiting*
Serotonin
Vomiting
Analgesics
Analgesics, Opioid
Antiemetics
Fentanyl
Granisetron
Isoflurane
Ketorolac
Serotonin