Journal of Acute Disease
Comparing the impacts of ephedrine, ketamine, ondansetron, and atropine on postoperative nausea and vomiting in patients with lower limb-fracture repair surgery: A randomized clinical trial
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Abstract:
"Objective: To compare the impacts of ephedrine, ketamine, ondansetron, and atropine on postoperative nausea and vomiting among patients with lower limb fracture repair surgery under spinal anesthesia. Methods: This randomized, double-blind trial was conducted at Valiasr Hospital, Arak, Iran. Participants were allocated via balanced block randomization into four groups: ephedrine, ketamine, ondansetron, and atropine. Nausea frequency (episode count) and severity (visual analogue scale [VAS]) were assessed at recovery and 2, 4, 6, 12, and 24 hours postoperatively. Severe nausea (VAS>3) was treated with intravenous metoclopramide (10 mg), with total 24-hour doses recorded. Sedation levels (Ramsay Sedation Scale) and medication side effects (e.g. , confusion, hallucinations) were evaluated at recovery and 1, 2, and 4 hours post-surgery. Data were analyzed using SPSS (v. 20.0), with P<0.05 considered significant.
Results: A total of 128 patients were included. No significant difference was observed among the groups concerning vomiting score and nausea frequency (P>0.05). Nausea severity in the ondansetron and ephedrine groups was significantly less than the other two groups (P=0.001) and nausea severity in the ondansetron group was significantly less than the ephedrine group (P=0.01). The Ramsay sedation score in the ketamine group was also significantly higher than the other groups at recovery and one hour after surgery (P=0.001).
Conclusions: Ondansetron and ephedrine are effective in significantly reducing postoperative nausea severity and ondansetron acts better. Therefore, these medications can be recommended for postoperative nausea and vomiting management."
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