PONV Clinical Trial
Official title:
Granisetron vs Granisetron and Dexamethasone on the Reduction of Postoperative Nausea and Vomiting After Caesarean Section With Intrathecal Morphine: A Randomized Controlled Trial
Intrathecal morphine (ITM) has proven to be excellent in reducing postoperative pain. However, its use has commonly been associated with the occurrence of postoperative nausea and vomiting (PONV). In recent years, the combination therapy of antiemetics comprising of a serotonin receptor antagonist and corticosteroid has been implemented to diminish the occurrence of PONV. Despite being routinely used, the evidence in the efficacy of this combination in parturients are conflicting and lacking. In this study, we wish to compare the efficacy between the combination therapy of granisetron plus dexamethasone versus granisetron alone on the occurrence of postoperative nausea and vomiting (PONV) in 126 parturients undergoing elective Caesarean delivery supplemented with intrathecal morphine.
126 parturients aged between 18 and 45 years old who falls within the American Society of
Anaesthesiology (ASA) physical status I and II undergoing Caesarean deliveries from the 1st
of October 2020 till the 1st of April 2021 will be enrolled. Informed and written consent
shall be obtained on recruitment.
Subjects will be randomised using a computer-generated randomisation software using block
size 3 into 2 groups; group A and group B each consisting of 63 subjects. The order of
interventions within each block was random as determined by computer random number generator.
This technique was chosen to ensure similar numbers of patients in each group at any point
during the study. Both patients and the assessors of PONV which is the Acute Pain Service
(APS) team will be blinded.
Patients are subjected to fasting 6 hours prior to surgery with clear fluid allowed up to 2
hours before surgery. Intravenous (IV) metaclopromide 10mg, IV ranitidine 50mg and mist
sodium citrate 30 mls will be administered as part of the acid aspiration prophylaxis.
Standard monitoring with continuous noninvasive blood pressure monitoring (NIBP),
electrocardiogram (ECG), respiratory rate and pulse oximetry (SpO2) will be implemented
throughout anaesthesia.
Ringer's lactate solution 10ml/kg will be infused for coloading to mitigate hypotension post
spinal anaesthesia. Spinal anaesthesia will be administered in the upright position,
implementing a height-based dose for heavy bupivacaine 0.5% administration. Based on the
subject's height, those who are less than 150cm, 151-154cm and those who are more than 155cm
will receive 1.5mls, 1.7mls and 1.9mls heavy bupivacaine 0.5% (AstraZeneca) respectively.
Fentanyl 15-20 mcg and morphine 0.1 mg are added to supplement the spinal anaesthesia.
On the completion of spinal anaesthesia, 4 mg of dexamethasone will be administered to
parturients in group A while group B received 1ml of normal saline injected intravenously.
1mg of IV granisetron will be administered to both groups of subjects after cord clamping.
These drugs will be given by the anaesthetist administering the spinal anaethesia. The
anaesthetist in charge is not blinded as this is of paramount importance in ensuring patients
safety should any complication arises during the delivery of anaesthesia.
Post surgery, subjects will be monitored in the recovery area for an hour. To supplement ITM
as the postoperative analgesia, tablet paracetamol 1g qid and voltaren 50mg tds will be
provided to patients postoperatively. The use of opioid is avoided during the first 24 hours
of intrathecal morphine administration. Patients will be monitored for complications of ITM
for 24 hours and assessments will be carried out by the APS team which include an anaesthetic
medical officer and 2 staff nurses.
Assessments are made at 1 hour post surgery, 4 hourly for 12 hours post surgery up to 24
hours after surgery. Episodes of nausea, retching and vomiting will be elicited by direct
questioning and recorded at each assessors' visit. Nausea is described as an unpleasant
sensation related to the urge to vomit. Retching is defined as an involuntary effort to vomit
but without the expulsion of the gastric contents, while vomiting is the when expulsion of
gastric contents occur.
The requirement of rescue antiemetics at each time interval will also be documented. Rescue
antiemetic is given when a patient developed one or more episodes of vomiting. IV ondansetron
4 mg is given to group A while either IV dexamethasone 4mg or iv ondansetron is given to
group B. Subsequent requirement of antiemetics will be decided based on the anaesthetist
discretion.
Sample size is calculated based the assumption that the combination of a serotonin receptor
antagonist with a corticosteroid would be superior than its monotherapy and thus, the
addition of dexamethasone to granisetron would reduce the incidence of PONV from 20% to 3.3%.
From the calculation using PS software, the sample required for each group is 57, and with
the additional 10% for dropout rate, this study required 63 patients in each group, giving a
total of 126 patients.
Data analysis will be performed using SPSS version 27 for MAC. The incidences of nausea,
retching, vomiting and the use of rescue antiemetic will be analysed using Chi-Square test.
Data is presented as percentage and a p-value of <0.05 is considered statistically
significant.
;
Status | Clinical Trial | Phase | |
---|---|---|---|
Recruiting |
NCT01945502 -
Nasopharyngeal Packing and Rhinologic Surgery.
|
N/A | |
Completed |
NCT01840254 -
Effect of Combination Dexmedetomidine Added to Fentanyl-based Intravenous Patient-controlled Analgesia on Nausea Vomiting in Highly Susceptible Patients Undergoing Lumbar Spinal Surgery: Prospective Double Blinded Randomized Controlled Trial
|
N/A | |
Completed |
NCT00760253 -
Compare the Side Effects and Difference Awake Level of Three TCI Propofol Formula in TVOR Patients
|
N/A | |
Completed |
NCT00772226 -
The Use of Music as Pain Therapy in Patients Undergoing Laparoscopic Cholecystectomy in a Day Care Unit
|
Phase 3 | |
Recruiting |
NCT03783182 -
Betamethasone (Betapred®) as Premedication for Reducing Postoperative Vomiting and Pain After Tonsillectomy
|
Phase 4 | |
Recruiting |
NCT03835234 -
Incidence and Factors Associated With PONV in Regional Anaesthesia
|
||
Recruiting |
NCT04191694 -
Chewing Gum to Prevent Nausea and Vomiting After Caesarean Section Under Spinal Anaesthesia
|
N/A | |
Completed |
NCT02468323 -
Prophylactic Antiemetic Efficacy of Palonosetron Versus Ondansetron for Cesarean Sections Under Regional Anesthesia
|
Phase 4 | |
Recruiting |
NCT05596695 -
Minimisation of Blood Pressure Variability and Postoperative Nausea and Vomiting
|
N/A | |
Completed |
NCT02116257 -
The Opioid-sparing Effect and Reduced PONV Using Propacetamol in PCA Among Patients With High Risk of PONV
|
N/A | |
Not yet recruiting |
NCT05396716 -
Acupoint Stimulation Alleviates Postoperative Nausea and Vomiting
|
N/A | |
Active, not recruiting |
NCT00892996 -
Efficacy of Prevention for Postoperative Nausea and Vomiting After Intrathecal Morphine in Cesarean Section
|
N/A | |
Recruiting |
NCT04866121 -
Acupuncture for Prevention of Postoperative Nausea and Vomiting
|
N/A | |
Completed |
NCT02809378 -
The Effects of Anesthetic Techniques and Palonosetron Administration on the Incidence of PONV
|
Phase 4 | |
Completed |
NCT05408676 -
Comparison of Dexamethasone Alone vs in Combination With Pericardium 6 (P6) Electrical Stimulation or Granisetron in the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Breast Cancer Surgery
|
N/A | |
Completed |
NCT01991821 -
European Phase III Study of APD421 in PONV
|
Phase 3 | |
Completed |
NCT00952133 -
Efficacy of IV Palo With IV Dexamethasone vs IV Palo for Prevention of Immediate & Delayed PONV
|
Phase 4 | |
Completed |
NCT04054479 -
Penehyclidine for PONV Prophylaxis After Strabismus Surgery
|
Phase 4 | |
Completed |
NCT05540236 -
Effects of Auricular Acupressure on the Management of Postoperative Nausea and Vomiting After Gynecological Laparoscopic Surgeries
|
N/A | |
Completed |
NCT03278522 -
Ramosetron Pre-treatment for PONV and QT Prolongation
|
Phase 4 |