Prophylaxis for vomiting by children after tonsillectomy: ondansetron compared with perphenazine

Area of Science:

• Pediatric Anesthesiology
• Pharmacology
• Surgical Outcomes

Background:

• Postoperative nausea and vomiting (PONV) are common complications following pediatric tonsillectomy.
• Effective antiemetic strategies are crucial for optimizing recovery and discharge in day-case surgery.

Purpose of the Study:

• To compare the efficacy of ondansetron and perphenazine in preventing vomiting after tonsillectomy in children.
• To identify predictors of postoperative vomiting and its impact on hospital stay.

Main Methods:

• A randomized, double-blind, stratified, blocked study involving 216 healthy children (aged 2-12 years).
• Anesthesia induced with propofol or halothane/nitrous oxide.
• Intravenous administration of ondansetron (150 µg/kg) or perphenazine (70 µg/kg) post-induction.
• Standardized perioperative management and discharge criteria.

Main Results:

• Ondansetron and perphenazine demonstrated comparable efficacy in controlling postoperative vomiting (44% vs 41%, P = 0.77).
• Male sex was the sole significant predictor of vomiting, with a higher incidence in males (49% vs 35%, P = 0.016).
• Each episode of in-hospital vomiting prolonged day-care unit stay by an average of 7 minutes (P = 0.015).

Conclusions:

• Ondansetron and perphenazine offer similar effectiveness for managing PONV in pediatric tonsillectomy patients.
• Male gender is a key risk factor for PONV post-tonsillectomy.
• Minimizing vomiting can contribute to shorter hospital stays in day-case pediatric surgery.