Effect of premedication with mirtazapine versus ondansetron on postoperative nausea and vomiting in breast surgery

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

Figure 1 Mean ± 95% Cl, state anxiety before, and after 1, 24 h of premedication by mirtazapine (M) and ondansetron (O). ^∗∗P < 0.01.

Table 1 Patient demographics and operative characteristics in mirtazapine M and ondansetron O groups. Data expressed in mean (SD), numbers (n).

Variable	Group M, n = 40	Group O, n = 40
Age (y)	45.5 (11.1)	47.9 (9.1)
Weight (kg)	65.7 (7.7)	67.9 (6.9)
Height (cm)	164 (3)	161 (3)
ASA status (I:II)	28:12	30:10
Days since last menstrual cycle (n)	14 (4)	15 (3)
Women with no menses (n)	6	6
Simplified risk score^a	2.6 (0.5)	2.7 (0.5)
State anxiety score	46 (10)	42 (8)
Trait anxiety score	48 (11)	44 (7)
Duration of operation (min)	110 (18)	112 (20)
Propofol dose (mg)	105 (16)	113 (26)
Isoflurane% maintenance	1.4 (0.3)	1.6 (0.5)
Intravenous fluids (ml)	1178 (481)	967 (390)
Time to awaken (min)	13.5 (2.2)	11.1 (1.6)

a The simplified risk score by Apfel and colleagues [13] could be assessed by four risk factors: female gender, non-smoking status, history of PONV or motion sickness, and postoperative opioids. If none, one, two, three, and four risk factors are present, the risk for PONV is approximately 10%, 20%, 40%, 60%, and 80%.

Table 2 Number of patients (%) with nausea and vomiting in mirtazapine (group M) and ondansetron (group O), at intervals 0–2, 2–24, 0–24 h after the end of surgery.

	Group M, n = 40	Group O, n = 40
0–2 h
Nausea	4 (10)	12 (30)^*
Vomiting	3 (7.5)	4 (10)
Nausea and vomiting	6 (15)	12 (30)
Rescue antiemetic	2 (5)	7 (17.5)
2–24 h
Nausea	7 (17.5)	12 (30)
Vomiting	1 (2.5)	8 (20)^*
Nausea and vomiting	8 (20)	12 (30)
Rescue antiemetic	2 (5)	5 (12.5)
0–24 h
Nausea	8 (20)	12 (30)
Vomiting	4 (10)	8 (20)
Nausea and vomiting	10 (25)	14 (35)
Rescue antiemetic	4 (10)	12 (30)^*
Complete response	30 (75)	26 (65)

* P < 0.05.

Table 3 Pain and sedation score, first opioids request, nalbuphine consumption, incidence of side effects, and time to discharge.

	Group M, n = 40	Group M, n = 40
VAS
6 h	2.9 ± 1.1	3 ± 0.8
12 h	3.3 ± 0.9	3.5 ± 0.5
18 h	2.5 ± 1.2	3.6 ± 1.2
24 h	2.8 ± 0.2	3.1 ± 1.5
Sedation score
6 h	1.9 ± 0.3	1.5 ± 0.3
12 h	1.7 ± 0.2	1.4 ± 0.2
18 h	1.7 ± 0.4	1.4 ± 0.1
24 h	1.4 ± 0.3	1.3 ± 0.3
First opioids demand (min)	87.8 (17.7)	60.2 (20.5)
Nalbuphine consumption (mg)
At 12 h	34.6 (6.7)	39.3 (4.9)
24 h after surgery	22.1 (4.1)	30.1 (2.3)
Side effects
Headache	3	2
Dizziness	–	–
Elevated liver enzymes	1	1
Somnolence	6	3
Dry mouth	2	2
Hospital discharge (h)	23.6 (4.3)	28.3 (2.6)

VAS = mean visual analog scale for pain. Sedation score = assessment by five points inverted observer’s assessment of alertness/sedation scale [10], with a score of 1 = awake alert to 5 = asleep, unarousable. Values are mean ± SD, or number of patients.