ONDANSETRON VERSUS KETOROLAC WITH ONDANSETRON FOR THE PROPHYLAXIS OF POSTOPERATIVE NAUSEA AND VOMITING IN PEDIATRIC PATIENTS UNDERGOING STRABISMUS SURGERY
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Date
2024-05-27
Authors
Osama Mohammed Sholi
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Publisher
An-Najah National University
Abstract
Background: Nausea and vomiting after strabismus surgery are frequent side effects that can cause electrolyte imbalance, dehydration, sub-conjunctival hemorrhage, and problems with surgical attachment. These ailments may necessitate re-admission, lengthen post-anesthesia care, and increase hospital stays and expenses.
Aims: Evaluating the effects of Ondansetron by itself versus Ondansetron plus Ketorolac on pain thresholds, the frequency of postoperative nausea and vomiting, and the consequent requirement for rescue antiemetic and analgesic drugs in pediatric strabismus patients.
Methods: Seventy pediatric patients (ASA I and II, ages 3 to 12) were split into two groups for elective strabismus surgery under general anesthesia: 40 for Ondansetron and 30 for Ondansetron plus Ketorolac. Postoperative nausea, vomiting, pain, and need for rescue medication were assessed from 30 minutes to 8 hours.
Results: Results from the PACU showed that the Ondansetron group (n=13, 32.5%) had a substantially higher incidence of surgical site pain than the combined Ondansetron and Ketorolac group (n=3, 10%; p= 0.042). Nevertheless, there were no significant variations between the two groups in terms of postoperative nausea, vomiting, retching, or the need for rescue drugs.
In the pediatric ward, all of the complications are significantly lower in prevalence in the combined group compared to the ondansetron group, including vomiting (0.0% vs 22.5%), p-value = 0.008), nausea (6.7% vs 32.5%, p-value = 0.017), retching (0.0% vs 22.5%, p-value = 0.008), surgical site pain (13.3% vs 42.5%, p-value = 0.009), use of analgesics (6.7% vs 35.0%, p-value = 0.008) and rescue antiemetic (0.0% vs 27.5%, p-value = 0.002), respectively.
In 8 hours postoperatively, there is a significantly lower incidence in the combined group compared to the ondansetron group in terms of nausea (0.0% vs 10%, p-value = 0.013), retching (0.0% vs 10%, p-value = 0.013), and the use of rescue medications (0.0% vs 10%, p-value = 0.013), while no significant differences in the Incidence of vomiting (0.0% vs 7.5%, p-value = 0.125) and use of analgesics (3.3% vs 10%, p-value = 0.284), respectively.
Conclusion: Ketorolac, administered as an adjuvant to Ondansetron in pediatric strabismus patients, has been shown to reduce pain and the subsequent need for analgesics and rescue antiemetic drugs, as well as postoperative nausea and vomiting. Keywords: