Clinical Efficacy of Sub-hypnotic Dose of Propofol and Ondansetron for Postoperative Nausea and Vomiting Prophylaxis in TKA or THR surgery: a Non-inferiority Trial

Abstract

Background: Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant symptoms affecting patients undergoing total knee arthroplasty (TKA) or total hip replacement (THR) surgery under spinal anesthesia with intrathecal morphine. It is a dreadful and uncomfortable experience that significantly detracts patients’ quality of life after surgery. Objective: This study was to assess the effect of a sub hypnotic dose of propofol on the incidence and severity of PONV after TKA or THR surgery. Methods: 144 patients presenting for elective TKA and THR surgery at Maharat Nakhon Ratchasima Hospital were recruited. Each patient was randomly assigned to two groups; Propofol group (n=72) received propofol 20 mg and ondansetron group (n=72) received ondansetron 8 mg IV slowly push 15 minutes after spinal anesthesia. Spinal anesthesia was performed using 0.5% hyperbaric or isobaric bupivacaine 12-16 mg with 0.2 mg intrathecal morphine. The episodes and severity of PONV during the first 24 h after anesthesia were evaluated. Results: Percentages of PONV after TKA and THR surgery under spinal anesthesia with intrathecal morphine of propofol group and ondansetron group were 30.6% and 37.5%, respectively. There was no significant difference between the two groups (P=0.84). There were no significant differences between the groups regarding to the hemodynamic parameters and sedative effects. Conclusion: Sub-hypnotic dose of propofol offers a PONV prophylaxis for patients undergoing TKA and THR surgery under spinal anesthesia with intrathecal morphine non-inferiorly to PONV prophylaxis with ondansetron.