Study the effect of intraperitoneal instillation vs intravenous ondansetron on PONV added to intraperitoneal bupivacaine for enhanced recovery and to decrease incidence of PONV after laparoscopic surgeries.
Laparoscopic surgeries have many advantages e.g., decreasing postoperative pain, better cosmetic, rapid recovery, and better recovery but also, it has side effects e.g., pain, postoperative nausea and vomiting. There are many risk factors that cause PONV either patient related factors or anesthesia related factors (opioids, inhalational anesthetics, Nitrous oxide and duration of anesthesia) and surgery related factors (intraabdominal, laparoscopic, postoperative pain). Intraperitoneal instillation of drugs can be used for instillation of LA, opoids, ketamine and antiemetics to provide analgesia and manage side effects of laparoscopic surgery. The mechanism of action of ondansetron is inhibition of presynaptic 5-HT3 receptors that located in the peripheral nervous. Study the effect of intraperitoneal instillation vs intravenous ondansetron on PONV added to intraperitoneal bupivacaine for enhanced recovery and to decrease incidence of PONV after laparoscopic surgeries.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
63
The aim is to detect the effect of intraperitoneal instillation of ondansetron for prevention of postoperative nausea and vomiting
The aim is to detect effect of intravenous ondansetron for prevention of postoperative nausea and vomiting
The aim is to detect effect of intraperitoneal instillation of bupivacaine
faculty of human medicine, Zagazig university hospitals
El Sharkia, Egypt
measure incidence of postoperative nausea and vomiting
The number of patient suffering from postoperative nausea and vomiting in each group
Time frame: 24 hours postoperative
measure severity of postoperative nausea and vomiting
Simplified Postoperative Nausea and Vomiting Impact Scale (S-PNVIS) 1. \*Frequency of Nausea:\* * 0: None * 1: Occasionally (1-2 times a day) * 2: Frequently (3-4 times a day) * 3: Constantly (more than 4 times a day) 2. \*Frequency of Vomiting:\* * 0: None * 1: Once a day * 2: 2-3 times a day * 3: More than 3 times a day 3. \*Impact on Daily Activities:\* * 0: No impact * 1: Mild impact (able to perform most activities) * 2: Moderate impact (some activities limited) * 3: Severe impact (most activities limited) #Scoring * \*Total Score:\* Sum of scores from all 3 items. * \*Interpretation:\* Higher total scores indicate a greater impact of nausea and vomiting on the patient recovery
Time frame: 24 hours postoperative
measure total numbers of rescue antiemetic
patients will receive 10 mg intravenous metoclopramide as rescue antiemetic immediately
Time frame: all over 24 hours postoperative.
Duration of hospital stay
time from PACU discharge till time to discharge home
Time frame: 24 hours to 72 hours
postoperative pain by Numerical Rating Scale
10 cm line numbered from 0 to 10, patients instructed to circle the number that represents his/her pain intensity (0=no pain and 10=maximum pain)
Time frame: 0 hour (basal) in PACU, 2, 4, 8, 12, 24 hours postoperative
total dose of rescue analgesia postoperative
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total dose of diclofenac as rescue analgesia postoperative
Time frame: 24 hours postoperative
Patient satisfaction
degree of satisfaction of the analgesia by using a 5-points Likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia)
Time frame: 24 hours postoperative