BMJ, doi: 10.1136/bmj.38903.419549.80, (Published 21 July 2006)

RESEARCH

Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone: randomised double blind multicentre trial

Jan Wallenborn ¹, Götz Gelbrich ^2*, Detlef Bulst ³, Katrin Behrends ¹, Hasso Wallenborn ⁴, Andrea Rohrbach ¹, Uwe Krause ⁵, Thomas Kühnast ⁶, Martin Wiegel ¹, Derk Olthoff ¹

¹ Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, D-04103 Leipzig, Germany
² Coordination Centre for Clinical Trials Leipzig, University of Leipzig, D-04107 Leipzig
³ Bad Düben Forest Hospital, D-04849 Bad Düben, Germany
⁴ Wurzen District Hospital, D-04808 Wurzen, Germany
⁵ Grimma District Hospital, D-04668 Grimma, Germany
⁶ Weissenfels District Hospital, D-06667 Weissenfels, Germany

^* Correspondence to: goetz.gelbrich{at}kksl.uni-leipzig.de.

Objectives To determine whether 10 mg, 25 mg, or 50 mg metoclopramide combined with 8 mg dexamethasone, given intraoperatively, is more effective in preventing postoperative nausea and vomiting than 8 mg dexamethasone alone, and to assess benefit in relation to adverse drug reactions.

Design Four-armed, parallel group, double blind, randomised controlled clinical trial.

Setting Four clinics of a university hospital and four district hospitals in Germany.

Participants 3140 patients who received balanced or regional anaesthesia during surgery.

Main outcome measures Postoperative nausea and vomiting within 24 hours of surgery (primary end point); occurrence of adverse reactions.

Results Cumulative incidences (95% confidence intervals) of postoperative nausea and vomiting were 23.1% (20.2% to 26.0%), 20.6% (17.8% to 23.4%), 17.2% (14.6% to 19.8%), and 14.5% (12.0% to 17.0%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide. In the secondary analysis, 25 mg and 50 mg metoclopramide were equally effective at preventing early nausea (0-12 hours), but only 50 mg reduced late nausea and vomiting (>12 hours). The most frequent adverse drug reactions were hypotension and tachycardia, with cumulative incidences of 8.8% (6.8% to 10.8%), 11.2% (9.0% to 13.4%), 12.9% (10.5% to 15.3%), and 17.9% (15.2% to 20.6%) for 0 mg, 10 mg, 25 mg, and 50 mg metoclopramide.

Conclusion The addition of 50 mg metoclopramide to 8 mg dexamethasone (given intraoperatively) is an effective, safe, and cheap way to prevent postoperative nausea and vomiting. A reduced dose of 25 mg metoclopramide intraoperatively, with additional postoperative prophylaxis in high risk patients, may be equally effective and cause fewer adverse drug reactions.

Trial registration Current Controlled Trials ISRCTN31625370.

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(Accepted 31 May 2006)
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