Comparison of granisetron, metoclopramide and gastric decompression for prevention of postoperative nausea and vomiting after fast track cardiac anesthesia

Different methods have been suggested to prevent postoperative nausea and vomiting (PONV), but the efficacy of these methods has not been fully studied in fast track cardiac anesthesia (FTCA). In a randomized double blind clinical trial study, 120 patients aged 18-70 years with ASA II or III, undergoing elective cardiac surgery, were selected. They were divided randomly into four groups. In group M, group G and group P, intravenous (IV) metoclopramide (0.1 mg/kg), granisetron (0.01 mg/kg), and normal saline were administered, respectively, about thirty minutes before extubation in the intensive care unit (ICU). In group N, a nasogastric (NG) tube was inserted after tracheal intubation in the operating room and removed about thirty minutes before extubation in the ICU. The incidence and severity of nausea and the episodes of vomiting were recorded by a blinded investigator at the time of extubation and performed regularly for a maximum of 24 hours. Assessment of severity of nausea was scored using a visual analogue scale (VAS) device. Data were analyzed by using ANOVA, chi-squared and Kruskal- Wallis and repeated measures tests. Overall the 24-h incidence of PONV was significantly lower in the G and M groups than in the P and N groups (10% and 16.7% vs. 33.3% and 40%, respectively; P < 0.02). Postoperative rescue medication was significantly less required in the G and M groups compared to the other two groups (P < 0.01). Less satisfaction, according to PONV status, was observed in the P and N groups (P < 0.01). According to this study, metoclopramide and granisetron, but not gastric decompression, are effective regimens for preventing PONV after FTCA. Given the economics and a considerable background incidence in patients exhibiting PONV, we suggest metoclopramide as a routine prophylactic antiemetic in FTCA.