Comparison of the effects of two drug combinations metoclopramide-acetaminophen, and metoclopramide-ketamine on postoperative pain, nausea, and vomiting after deep vitrectomy surgery- A randomized controlled clinical trial

authors:

avatar Hamid Haji Gholam Saryazdi , avatar Darioush Moradi Farsani ORCID , * , avatar Seyede ShadiHoseini , avatar Hossein Mahjobipoor ORCID

Koomesh: Vol.24, issue 6; 796-806
published online: December 01, 2022
article type: Research Article
received: August 02, 2021
accepted: June 01, 2022

how to cite: Haji Gholam Saryazdi H, Moradi Farsani D, ShadiHoseini S, Mahjobipoor H. Comparison of the effects of two drug combinations metoclopramide-acetaminophen, and metoclopramide-ketamine on postoperative pain, nausea, and vomiting after deep vitrectomy surgery- A randomized controlled clinical trial. koomesh. 2022;24(6):e152792. 

Abstract

Introduction: According to the high incidence and complications of postoperative pain, nausea, and vomiting the current study aimed to assess the combination of acetaminophen-metoclopramide and ketamine-metoclopramide in comparison with a control group in decreasing post-vitrectomy pain, nausea, and vomiting. Materials and Methods: The current randomized clinical trial has been conducted on 96 patients undergoing elective deep vitrectomy in three treatment groups of acetaminophen-metoclopramide(n=32) which received acetaminophen (10 mg/kg) and metoclopramide (0.15 mg/kg); ketamine-metoclopramide(n=32) which received ketamine (0.1 mg/kg) and metoclopramide (0.15 mg/kg); and the control group (n=32) who received 100 ml of sterile normal saline, all of the drugs were infused intravenously and within 20 minutes before the end of the procedure.  Pain and nausea intensity based on Visual Analogue Scale (VAS) and vomiting incidence and vital signs in the first postoperative 24 hours were assessed. Results: Hemodynamic parameters did not statistically differ between the study groups during the first 24 hours after surgery. Significant improvements were noticed in all the groups regarding pain, nausea intensity, and vomiting incidence in all the groups (P-value<0.05); however, the comparison of the groups showed the lowest pain (P-value=0.001), nausea (P-value=0.04) intensity scores and vomiting incidence (P-value=0.01) in ketamine-metoclopramide treated patients. Conclusion: Based on the findings of this study, both acetaminophen-metoclopramide and ketamine-metoclopramide significantly reduced pain, nausea, and vomiting; however, generally, ketamine-metoclopramide had better results. None of the drug compounds caused serious side effects and hemodynamic disturbances

References

  • 1.

    Fekrat S, Elsing SH, Raja SC, Campochiaro PA, de JUAN Jr E, Haller JA. Eye pain after vitreoretinal surgery: a prospective study of 185 patients. Retina 2001; 21: 627-632.

  • 2.

    Mimouni M, Abualhasan H, Mtanes K, Mazzawi F, Barak Y. Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy. J Ophthalmology 2019; 2019.

  • 3.

    Morgan B, Stanik-Hutt J. Utilization of a preemptive, multimodal analgesic regimen in adult ambulatory septoplasty patients: a quality improvement project. ORL Head Neck Nurs 2015; 33: 6-13.

  • 4.

    Foroughian M, Abiri S, Akbari H, Shayesteh V, Habibzadeh R, Alsana F, et al. Effectiveness of intravenous lidocaine versus intravenous morphine in reducing acute extremity trauma-induced pain: A triple-blind randomized clinical trial. Koomesh 2020; 22: 411-418. (Persian).##https://doi.org/10.29252/koomesh.22.3.411.

  • 5.

    De Oliveira Jr GS, Castro-Alves LJ, McCarthy RJ. Single-dose systemic acetaminophen to prevent postoperative pain: a meta-analysis of randomized controlled trials. Clin J Pain 2015; 31: 86-93.

  • 6.

    Imani F, Faiz HR, Sedaghat M, Hajiashrafi M. Effects of adding ketamine to fentanyl plus acetaminophen on postoperative pain by patient controlled analgesia in abdominal surgery. Anesth Pain Med 2014; 4.

  • 7.

    Valadan M, Banifatemi S, Yousefshahi F. Preoperative gabapentin to prevent postoperative shoulder pain after laparoscopic ovarian cystectomy: a randomized clinical trial. Anesth Pain Med 2015; 5: e31524.

  • 8.

    Alimian M, Imani F, Hassani V, Rahimzadeh P, Sharifian M, Safari S. Effects of single-dose pregabalin on postoperative pain in dacryocystorhinostomy surgery. Anesth Pain Med 2012; 2: 72.

  • 9.

    Coppens M, Versichelen L, Mortier E. Treatment of postoperative pain after ophthalmic surgery. Bull Soc Belge Ophtalmol 2002; 285: 27-36.

  • 10.

    Doleman B, Read D, Lund JN, Williams JP. Preventive acetaminophen reduces postoperative opioid consumption, vomiting, and pain scores after surgery: systematic review and meta-analysis. Reg Anesth Pain Med 2015; 40: 706-712.

  • 11.

    Hickman SR, Mathieson KM, Bradford LM, Garman CD, Gregg RW, Lukens DW. Randomized trial of oral versus intravenous acetaminophen for postoperative pain control. Am J Health Syst Pharm 2018; 75: 367-375.

  • 12.

    Bedwell JR, Pierce M, Levy M, Shah RK. Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization. Otolaryngol Head Neck Surg 2014; 151: 963-966.

  • 13.

    Singh H, Kundra S, Singh RM, Grewal A, Kaul TK, Sood D. Preemptive analgesia with ketamine for laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol 2013; 29: 478.

  • 14.

    Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: a narrative review. Bio Med Res Intern 2015; 2015.

  • 15.

    Jouguelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous infusion or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med 2015; 16: 383-403.

  • 16.

    Shabanian S, Kalbasi S, Shabanian G, Khoram B, Ganji F. The effect of metoclopramide addition to lidocaine on pain of patients with grades II and III post-episiotomy repair. J Clin Diagnos Res 2017; 11: QC11.

  • 17.

    Farhat K, Pasha AK, Kazi WA. Comparison of ondansetron and metoclopramide for PONV prophylaxis in laparoscopic cholecystectomy. J Anesthe Clinic Res 2012; 4: 297.##https://doi.org/10.4172/2155-6148.1000297.

  • 18.

    Isazadehfar K, Entezariasl M, Shahbazzadegan B, Nourani Z, Shafaee Y. The comparative study of ondansetron and metoclopramide effects in reducing nausea and vomiting after laparoscopic cholecystectomy. Acta Medica Iranica 2017; 55: 254-258.

  • 19.

    Gibbs R, Movinsky B, Pellegrini J, Vacchiano C. The morphine-sparing effect of metoclopramide on postoperative laparoscopic tubal ligation patients. AANA J 2002; 70: 27-32.

  • 20.

    Malekshoar M, Jarineshin H, Kalani N, Vatankhah M. Comparing the effect of metoclopramide and promethazine on preventing nausea and vomiting after laparoscopic cholecystectomy: A double-blind clinical trial. Koomesh 2021; 23: 203-210. (Persian).##https://doi.org/10.52547/koomesh.23.2.203.

  • 21.

    Sadeghi A, Mirkheshti A. Antiemetic effects of deroperidol compared with dexamethasone and metoclopramide in patients undergoing hysteroscopy: A randomized double - blinded clinical trial. Iran J Anesth Crit Care 2016; 2: 51-58.

  • 22.

    Reibaldi M, Fallico M, Longo A, Avitabile T, Astuto M, Murabito P, et al. Efficacy of three different prophylactic treatments for postoperative nausea and vomiting after Vitrectomy: a randomized clinical trial. J Clin Med 2019; 8: 391.

  • 23.

    Heydari SM, Hashemi SJ, Pourali S. The comparison of preventive analgesic effects of ketamine, paracetamol and magnesium sulfate on postoperative pain control in patients undergoing lower limb surgery: a randomized clinical trial. Adv Biomed Res 2017; 6.

  • 24.

    Joshi A, Kale S, Chandel S, Pal DK. Likert Scale: Explored and Explained. Br J Appl Sci Technol 2015; 7: 396-403.##https://doi.org/10.9734/BJAST/2015/14975.

  • 25.

    Brodner G, Gogarten W, Van Aken H, Hahnenkamp K, Wempe C, Freise H, et al. Efficacy of intravenous paracetamol compared to dipyrone and parecoxib for postoperative pain management after minor-to-intermediate surgery: a randomised, double-blind trial. Eur J Anaesth 2011; 28: 125-132.

  • 26.

    Lombardi TM, Kahn BS, Tsai LJ, Waalen JM, Wachi N. Preemptive oral compared with intravenous acetaminophen for postoperative pain after robotic-assisted laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2019; 134: 1293-1297.

  • 27.

    Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C. Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. J Am Soc Anesth 2005; 102: 822-831.

  • 28.

    Shaffer EE, Pham A, Woldman RL, Spiegelman A, Strassels SA, Wan GJ, et al. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. Adv Ther 2016; 33: 2211-2228.

  • 29.

    Singla NK, Hale ME, Davis JC, Bekker A, Gimbel J, Jahr J, et al. IV acetaminophen: efficacy of a single dose for postoperative pain after hip arthroplasty: subset data analysis of 2 unpublished randomized clinical trials. Am J Ther 2015; 22: 2-10.

  • 30.

    Stundner O, Poeran J, Ladenhauf HN, Berger MM, Levy SB, Zubizarreta N, et al. Effectiveness of intravenous acetaminophen for postoperative pain management in hip and knee arthroplasties: a population-based study. Reg Anesth Pain Med 2019; 44: 565-572.

  • 31.

    Crisp CC, Khan M, Lambers DL, Westermann LB, Mazloomdoost DM, Yeung JJ, et al. The effect of intravenous acetaminophen on postoperative pain and narcotic consumption after vaginal reconstructive surgery: a double-blind randomized placebo-controlled trial. Female Pelvic Med Reconstr Surg 2017; 23: 80-85.

  • 32.

    Yang L, Zhang J, Zhang Z, Zhang C, Zhao D, Li J. Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis. Acta Cir Bras 2014; 29: 819-825.

  • 33.

    Tuchscherer J, McKay WP, Twagirumugabe T. Low-dose subcutaneous ketamine for postoperative pain management in Rwanda: a dose-finding study. Can J Anaesth 2017; 64: 928-934.

  • 34.

    Azari P, Lindsay DR, Briones D, Clarke C, Buchheit T, Pyati S. Efficacy and safety of ketamine in patients with complex regional pain syndrome. CNS Drugs 2012; 26: 215-228.

  • 35.

    Moradi FD, Safari M, Heidari S. Comparative study of preemptive effects of ketamine, paracetamol, and metoclopramide on the postoperative pain of the patients following cataract surgery with general anesthesia. 2019. (Persian).

  • 36.

    Heydari SM, Hashemi SJ, Pourali S. The comparison of preventive analgesic effects of ketamine, paracetamol and magnesium sulfate on postoperative pain control in patients undergoing lower limb surgery: a randomized clinical trial. Adv Biomed Res 2017; 6.