Prophylaxis of postoperative nausea and vomiting: Gabapentin a new anti-emetic approach?
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen Bremserstraße 79, D-67063 Ludwigshafen, Germany
S N Piper
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen Bremserstraße 79, D-67063 Ludwigshafen
|How to cite this article:|
Piper S N. Prophylaxis of postoperative nausea and vomiting: Gabapentin a new anti-emetic approach?.J Postgrad Med 2006;52:100-101
|How to cite this URL:|
Piper S N. Prophylaxis of postoperative nausea and vomiting: Gabapentin a new anti-emetic approach?. J Postgrad Med [serial online] 2006 [cited 2021 May 11 ];52:100-101
Available from: https://www.jpgmonline.com/text.asp?2006/52/2/100/25152
Every third patient undergoing general anaesthesia suffers from postoperative nausea and vomiting (PONV). Although more than 1000 investigations on prevention or treatment of PONV have been published, the incidence of PONV has been unchanged over the past two decades. The ideal drug has not yet been found and no gold-standard exists. The occurence of PONV depends on numerous factors including female gender, non-smoking status, a history of previous PONV and/or motion sickness, the duration of anaesthesia and the postoperative use of opioids. Although less important, PONV may be influenced by the type of surgery as well, especially strabismus correction and laparoscopic surgery have been described as risk-factors of PONV., Therefore, in patients with a high risk profile of PONV, including the above mentioned factors attributing to a higher incidence of PONV (e.g. non-smoking females of child-bearing age with a previous episode of nausea or/and vomiting or kinetosis in the patient's history), combinations of antiemetic interventions have been recommended., In a large study, Christian Apfel and colleagues showed that various anti-emetic strategies are associated with a very similar and constant relative reduction rate of about 25-30%. All evaluated anti-emetic approaches (dexamethasone, droperidol, total intravenous anaesthesia and ondansetron) work independently, so consequently their combined benefit can be derived directly from the single effects.
The present issue of the Journal contains an article reporting the results of a trial evaluating the efficacy of the antiepileptic drug gabapentin for prevention of PONV. The authors were able to demonstrate, that gabapentin has antiemetic properties of clinical relevance. However, more clinical trials are needed to evaluate dose-finding and safety-studies, as well as comparisons to established antiemetic strategies and a potential combined benefit of gabapentin and other established anti-emetic interventions. The present study raises hope that gabapentin might be an effective and safe new approach in the clinical antiemetic portfolio that may be used as a component of a multimode solution using various antiemetic interventions for high-risk patients. However, avoiding PONV while minimizing the chances of producing unwanted side-effects still remains a challenge.
|1||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.|
|2||White PF. Prevention of postoperative nausea and vomiting - a multimodal solution to a persistent problem. N Engl J Med 2004;350:2511-2.|
|3||Tramer MR. A rational approach to the control of postoperative nausea and vomiting:evidence from systemic reviews. I. Efficacy and harm of antiemetic interventions and methodological issues. Acta Anaesthesiol Scand 2001;45:4-13.|
|4||Piper SN, Suttner SW, R φhm KD, Maleck WH, Larbig E, Boldt J. Dolasetron, but not metoclopramide prevents nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Can J Anaesth 2002;49:1021-8.|
|5||Apfel CC, Greim CA, Haubitz I, Grundt D, Goepfert C, Sefrin P, et al . The discriminating power of a risk score for postoperative vomiting in adults undergoing various types of surgery. Acta Anaesthesiol Scand 1998;42:502-9.|
|6||Pandey CK, Priye S, Ambesh SP, Singh S, Singh U, Singh PK. Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized, double-blind, placebo-controlled study. J Postgard Med 2006;52:95-9.|