Comparative Study of Ondansetron, Haloperidol or Midazolam in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Gynecological Operations

Abstract
Background: Post-Operative Nausea and Vomiting (PONV) is a common, undesirable effect after surgery per-formed under general anesthesia.
Aim of Study: The aim of this study is to compare the effect of ondansetron, haloperidol or midazolam in the pre-vention of PONV in non-smoker females undergoing laparo-scopic gynecological operations under general anesthesia.
Patient and Methods: This prospective randomized con-trolled study carried out in Tanta University Hospital for six months (from November 2016 to April 2017). This study included 90 nonsmoker female patients, aged between 18 and 60 years, ASA I & II, scheduled for laparoscopic gynecological operations under general anesthesia. The anesthetic technique, drugs, monitoring, and care were standardized in all the patients during the perioperative period. Patients were ran-domly allocated to one of three groups (n=30 for each group): Group I ondansetron (O) 4mg I.V ondansetron was given at the end of surgery. Group II haloperidol (H) 1mg I.V haloperi-dol was given at the end of surgery. Group III midazolam (M) 2mg I.V midazolam was given 30 minutes before the end of surgery. Dexamethasone 4mg was added to each study group after induction of anesthesia. For the first 24 hours after anesthesia, the presence or absences of nausea, vomiting or retching were recorded. Rescue antiemetic was given if the patient complains of PONV.
Results: Mean response during 0-24 hours was 86.7%, 80%, 83.3% in ondansetron, haloperidol and midazolam groups, respectively. No significant difference through the three groups was found. (p-value=0.787). Regarding rescue antiemetics, there was no statistically significant difference between the three groups. Upon arrival to PACU and after 60 minutes, there was no statistically significant difference in sedation score.
Conclusion: In the studied surgical population, the efficacy and toxicity of post-operative nausea and vomiting prophylaxis with haloperidol 1mg or midazolam 2mg were not significantly different from ondansetron 4mg.