Intravenous ondansetron for postsurgical opioid-induced nausea and vomiting. S3A-255 Study Group

Area of Science:

• Anesthesiology
• Pharmacology
• Gastroenterology

Background:

• Opioid analgesics are crucial for postoperative pain management.
• Opioid use can lead to significant side effects like nausea and vomiting, limiting their efficacy.
• Selective serotonin type 3 (5-HT3) antagonists, such as ondansetron, are known to be effective against anesthesia- and chemotherapy-induced nausea and vomiting.

Purpose of the Study:

• To investigate the efficacy of ondansetron in mitigating opioid-induced nausea and vomiting (OINV) in the postoperative setting.
• To evaluate the impact of different intravenous doses of ondansetron on emetic episodes, nausea, pain, and patient satisfaction.

Main Methods:

• A double-blind, randomized, placebo-controlled study was conducted on patients (ASA physical status I-III) undergoing regional anesthesia.
• Eligible patients received a single intravenous dose of ondansetron (0.1 mg, 4 mg, or 16 mg) or placebo upon requesting an antiemetic post-opioid administration.
• Outcomes including emetic episodes, nausea and pain ratings, adverse events, and patient satisfaction were assessed over 24 hours.

Main Results:

• A significantly higher proportion of patients receiving ondansetron 4 mg and 16 mg experienced no emetic episodes and required no rescue antiemetics compared to placebo (P < 0.05).
• The 16 mg ondansetron group reported significantly lower nausea scores and higher patient satisfaction compared to the placebo group (P < 0.05).
• No significant differences in postsurgical pain scores or adverse event incidence were observed across the treatment groups.

Conclusions:

• Intravenous ondansetron is effective in managing postoperative opioid-induced nausea and vomiting.
• Ondansetron, particularly at 4 mg and 16 mg doses, offers a viable solution for improving patient comfort and satisfaction after surgery when using opioids for pain relief.