British Journal of Anaesthesia, 2002, Vol. 89, No. 3 473-478
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
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Management of post-strabismus nausea and vomiting in children using ondansetron: a value-based comparison of outcomes
1 All India Institute of Medical Sciences New Delhi, India
2 Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
3 Northern General Hospital, Sheffield Teaching Hospital NHS Trust Sheffield, UK
*Corresponding author: Department of Anesthesia, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Harvard Medical School, Boston, MA 02115, USA
Background. This study evaluated the clinical efficacy and cost-effectiveness of prophylactic ondansetron versus early ondansetron treatment in the management of postoperative nausea and vomiting (PONV) in children undergoing strabismus repair using clinically meaningful outcomes and value-based principles.
Methods. One hundred and fifty children were randomly assigned to either prophylactic (P) or early symptomatic treatment only (T) group (n = 75). Children in group P received ondansetron 100 µg kg–1 i.v. and those in group T received placebo at the end of the procedure. After surgery, at the earliest sign of nausea or vomiting, children in both groups received ondansetron 100 µg kg–1 i.v. Besides the incidence of PONV, non-surrogate (fast tracking time, duration of stay in the postanaesthesia care unit (PACU) and parental satisfaction scores), therapeutic (numbers needed to prevent and treat) and pharmacoeconomic (cost to benefit a child and cost per PONV-free child) outcome measures were evaluated.
Results. The incidences of PONV in the immediate, early, late and first 24-h periods were significantly less in group P (20, 12, 19 and 35% respectively) than in group T (37, 29, 47 and 72%, P<s0.05). Time to achieve fast-track eligibility and duration of PACU stay were significantly shorter in group P (P<0.00l). Children in group P had superior mean (SD) parental satisfaction scores (8.2 (1.8)) compared with those in group T (6.8 (1.7), P<0.001). The number needed to prevent PONV was 2 and the number needed to treat PONV was 9. The cost to benefit a child was more than fourfold less and the cost per PONV-free child was 35% less in group P.
Conclusions. Compared with early symptomatic treatment with ondansetron, prophylactic ondansetron shortened fast-tracking time and duration of PACU stay and improved parental satisfaction and therapeutic outcomes at a lower direct cost.
vomiting, postoperative nausea and vomiting vomiting, antiemetics, ondansetron anaesthesia, audit
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