This prospective, randomized, placebo-controlled, double-blind study was designed to evaluate the efficacy of
ondansetron, a
5-HT3 antagonist, in preventing
postoperative nausea and vomiting (
PONV) after elective
craniotomy in adult patients. The authors also tried to discover certain predictors for postcraniotomy
nausea and
vomiting. We studied 170 ASA physical status I and II patients, aged 15 to 70 years, undergoing elective
craniotomy for resecting various intracranial
tumors and vascular lesions. A standardized
anesthesia technique and postoperative
analgesia were used for all patients. Patients were divided into two groups and received either saline placebo (Group 1) or
ondansetron 4 mg (Group 2) intravenously at the time of dural closure. Patients were extubated at the end of surgery and episodes of
nausea and
vomiting were noted for 24 hours postoperatively in the neurosurgical intensive care unit. Demographic data, duration of surgery, and
anesthesia and
analgesic requirements were comparable in both groups. Overall, a 24-hour incidence of
postoperative emesis was significantly reduced in patients who received
ondansetron compared with those who received a saline placebo (39% in Group 1 and 11% in Group 2, P = .001). There was a significant reduction in the frequency of
emetic episodes and rescue
antiemetic requirement in patients treated with
ondansetron; however,
ondansetron did not significantly reduce the incidence of
nausea alone (14% in Group 2 vs 5% in Group 1, P = .065). Prophylactic
ondansetron had a favorable influence on
PONV outcome measures such as patient satisfaction and number needed to prevent
emesis (3.5). Side effects were similar in both groups. We conclude that
ondansetron 4 mg given at the time of dural closure is safe and effective in preventing
emetic episodes after elective
craniotomy in adult patients.