- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT07638527
Time to First Rescue Antiemetic With Ondansetron Plus Metoclopramide Versus Dexamethasone Plus Metoclopramide for PONV Prophylaxis in Laparoscopic Cholecystectomy
Time-to-first-rescue Antiemetic With Ondansetron Plus Metoclopramide Versus Dexamethasone Plus Metoclopramide for PONV Prophylaxis in Laparoscopic Cholecystectomy: a Randomized, Triple-Blind, Superiority Trial
The goal of this superiority randomized controlled trial (RCT) is to learn if one dual-drug arm increases patient comfort (time to needing rescue medication for nausea/vomiting) more effectively than the other in adults with Moderate-to-High PONV risk (Apfel score 2-4) undergoing elective laparoscopic cholecystectomy (gallbladder surgery).
The main question this study aims to answer is:
• Does Ondansetron plus Metoclopramide prolong time to first rescue antiemetic more than Dexamethasone plus Metoclopramide?
Researchers will compare Group A (Ondansetron 4mg plus Metoclopramide 10mg IV) to Group B (Dexamethasone 8mg IV plus Metoclopramide 10mg IV) to see if Group A provides a longer time to first rescue medication.
Participants will:
- Receive their assigned, blinded drug group 5-10 minutes before general anesthesia induction.
- Receive rescue Metoclopramide 10mg IV if they experience any vomiting or severe nausea
- Be monitored for 24 hours post-surgery in the hospital
- Report nausea severity at 2, 6, 12 and 24 hours post-surgery
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Tipo di studio
Iscrizione (Stimato)
Fase
- Fase 4
Contatti e Sedi
Contatto studio
- Nome: Asifa Saeed, MBBS; FCPS
- Numero di telefono: +923006694460
- Email: drasifasaeed@gmail.com
Backup dei contatti dello studio
- Nome: Huda Ather, MBBS
- Numero di telefono: +923047922909
- Email: atherhudaather@gmail.com
Luoghi di studio
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Punjab Province
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Faisalābad, Punjab Province, Pakistan, 38000
- Faisalabad Medical University
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Contatto:
- Asifa Saeed, MBBS; FCPS
- Numero di telefono: +923006694460
- Email: drasifasaeed@gmail.com
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Contatto:
- Huda Ather, MBBS
- Numero di telefono: +923047922909
- Email: atherhudaather@gmail.com
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Investigatore principale:
- Asifa Saeed, MBBS; FCPS
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Sub-investigatore:
- Huda Ather, MBBS
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Sub-investigatore:
- M. Ibtisam Ahmad, MBBS
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
Inclusion Criteria:
- Age ≥ 18 years
- American Society of Anesthesiologists (ASA) physical status I or II
- Scheduled for elective laparoscopic cholecystectomy
- Apfel score 2-4 (moderate to high risk for PONV)
- Provides written informed consent prior to enrollment
Exclusion Criteria:
- Known allergy or hypersensitivity to ondansetron, dexamethasone, or metoclopramide
- Emergency surgery (e.g., acute cholecystitis, perforation, or gangrene)
- Pregnancy or breastfeeding
- ASA physical status III or IV
- Preexisting hepatic impairment
- Baseline corrected QT (QTc) interval > 420 ms on pre-operative ECG
- History of dystonic reaction to metoclopramide or other dopamine antagonists
- Preexisting renal impairment (e.g., serum creatinine > 1.5 mg/dL or on dialysis)
- Unable or unwilling to provide informed consent
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Prevenzione
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Triplicare
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
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Sperimentale: Group A (Ondansetron and Metoclopramide)- Separate syringes
Participants receive
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Ondansetron 4 mg IV administered as a single colorless syringe 5-10 minutes before induction of anesthesia for prevention of postoperative nausea and vomiting.
Altri nomi:
Metoclopramide 10 mg IV administered as a single colorless syringe 5-10 minutes before induction of anesthesia as part of dual-agent PONV prophylaxis.
Also used as rescue antiemetic (10 mg IV) if patient has vomiting or VRS >4 for nausea.
Altri nomi:
|
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Comparatore attivo: Group B (Dexamethasone and Metoclopramide)- Separate syringes
Participants receive
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Metoclopramide 10 mg IV administered as a single colorless syringe 5-10 minutes before induction of anesthesia as part of dual-agent PONV prophylaxis.
Also used as rescue antiemetic (10 mg IV) if patient has vomiting or VRS >4 for nausea.
Altri nomi:
Dexamethasone 8 mg IV administered as a single colorless syringe 5-10 minutes before induction of anesthesia for prevention of postoperative nausea and vomiting.
Altri nomi:
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Time to First Rescue Antiemetic (in minutes)
Lasso di tempo: First 24 hours after surgery (measured from the time of arrival to Post-anaesthesia care unit, PACU)
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Time in minutes from patient arrival to Post-anaesthesia care unit, PACU (time zero) to administration of rescue metoclopramide 10 mg IV.
Rescue is given if patient experiences any episode of vomiting/retching or reports a nausea Verbal Rating Scale (VRS) score >4.
VRS scale is no nausea (0), mild (1-3), moderate (4-6), and severe (7-10).
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First 24 hours after surgery (measured from the time of arrival to Post-anaesthesia care unit, PACU)
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Number of Rescue Doses Required
Lasso di tempo: First 24 hours after surgery
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Total number of rescue antiemetic (metoclopramide 10 mg IV) doses administered to each patient within the first 24 hours.
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First 24 hours after surgery
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Incidence of PONV
Lasso di tempo: 24 hours post-surgery
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Proportion of patients experiencing any nausea (VRS >1) or any vomiting/retching episode within the first 24 hours post-surgery. Verbal Rating Scale (VRS) is a well established measurement scale with a total of 11 points where 0 = no nausea and 10 = worst possible nausea. |
24 hours post-surgery
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Severity of Postoperative Nausea and Vomiting (RINVR Score)
Lasso di tempo: Measured at 2, 6, 12, and 24 hours post-surgery
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Measured using the Rhodes Index of Nausea, Vomiting, and Retching (RINVR).
It evaluates 8 dimensions: frequency/duration/distress of nausea; frequency/amount/distress of vomiting; and frequency/distress of retching.
Total score range is 0-32, with 0 indicating no nausea, 1-8 mild, 9-16 moderate, 17-24 severe, and 25-32 great nausea.
The higher scores indicate worse PONV.
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Measured at 2, 6, 12, and 24 hours post-surgery
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Patient Satisfaction with Antiemetic Treatment
Lasso di tempo: At hospital discharge (approximately 24 hours post-surgery)
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Patient-reported satisfaction measured on a 5-point Likert scale (Very Dissatisfied to Very Satisfied) at the end of hospital stay. Likert scale is a 5-point psychometric survey scale, with 1 indicating very disappointing and 5 indicating very satisfying. The higher the score, the better the treatment was. |
At hospital discharge (approximately 24 hours post-surgery)
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Altre misure di risultato
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Adverse Events
Lasso di tempo: From drug administration up to 24 hours post-surgery
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Proportion of patients experiencing any adverse reaction including allergic reaction, headache, perineal burning, dystonia, or QT prolongation on post-operative ECG.
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From drug administration up to 24 hours post-surgery
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Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Asifa Saeed, MBBS; FCPS, Faisalabad Medical University
Pubblicazioni e link utili
Pubblicazioni generali
- Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999 Sep;91(3):693-700. doi: 10.1097/00000542-199909000-00022.
- Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis. 2009 Dec;1(1):51-4.
- Mishriky BM, Habib AS. Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis. Br J Anaesth. 2012 Mar;108(3):374-83. doi: 10.1093/bja/aer509. Epub 2012 Feb 3.
- Weibel S, Rucker G, Eberhart LH, Pace NL, Hartl HM, Jordan OL, Mayer D, Riemer M, Schaefer MS, Raj D, Backhaus I, Helf A, Schlesinger T, Kienbaum P, Kranke P. Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis. Cochrane Database Syst Rev. 2020 Oct 19;10(10):CD012859. doi: 10.1002/14651858.CD012859.pub2.
- Alam, M. S., et al. (2025). Haloperidol Versus Dexmedetomidine As An Adjuvant to Ondansetron in Postoperative Nausea and Vomiting in Laparoscopic Cholecystectomy. Egyptian Journal of Surgery, 44(2), 456-463
- Abel UR, Jensen K, Karapanagiotou-Schenkel I, Kieser M. Some Issues of Sample Size Calculation for Time-to-Event Endpoints Using the Freedman and Schoenfeld Formulas. J Biopharm Stat. 2015;25(6):1285-311. doi: 10.1080/10543406.2014.1000546. Epub 2015 Jan 28.
- Naguib M, el Bakry AK, Khoshim MH, Channa AB, el Gammal M, el Gammal K, Elhattab YS, Attia M, Jaroudi R, Saddique A. Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth. 1996 Mar;43(3):226-31. doi: 10.1007/BF03011739.
- Chattopadhyay S, Biswas A, SK Samim Ferdows, Bhowmik DK, Dey S, Bi B. Comparison of Ondansetron, Dexamethasone and Ondansetron Plus Dexamethasone For The Prevention of Post-operative Nausea and Vomiting after Laparoscopic Cholecystectomy. Indian Journal of Clinical Anaesthesia. 2025;3(3):459-463. Accessed April 6, 2026.
- Korkusuz M, Et T. Effect of perioperative restrictive and liberal fluid regimens on postoperative nausea-vomiting and quality of recovery in laparoscopic cholecystectomy. World J Gastrointest Surg. 2025 Oct 27;17(10):110543. doi: 10.4240/wjgs.v17.i10.110543.
- Si XY, Wu LP, Li XD, Li B, Zhou YM. Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy. Asian J Surg. 2015 Jan;38(1):21-7. doi: 10.1016/j.asjsur.2014.04.005. Epub 2014 Jun 15.
- Ko-Iam W, Sandhu T, Paiboonworachat S, Pongchairerks P, Junrungsee S, Chotirosniramit A, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T. Metoclopramide, versus its combination with dexamethasone in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized controlled trial. J Med Assoc Thai. 2015 Mar;98(3):265-72.
- Gan TJ, Jin Z, Ayad S, Belani KG, Habib AS, Meyer TA, Urman RD, Andrew BY, Bergese SD, Chung F, Diemunsch P, Kovac AL, Candiotti K, Englesakis M, Grant MC, Hedrick TL, Huang H, Kranke P, Lloyd SJ, Manahan MA, Minkowitz HS, Philip BK, Phillips BJ, Simpson KD, Stever J. Fifth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: Executive Summary. Anesth Analg. 2025 Nov 14. doi: 10.1213/ANE.0000000000007816. Online ahead of print. No abstract available.
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Inizio studio (Stimato)
Completamento primario (Stimato)
Completamento dello studio (Stimato)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Complicanze postoperatorie
- Processi patologici
- Segni e sintomi, Digestivo
- Vomito
- Nausea
- Condizioni patologiche, segni e sintomi
- Segni e sintomi
- Nausea e vomito postoperatori
- Composti di zolfo
- Prodotti chimici organici
- Composti eterociclici, 1-anello
- Composti eterociclici
- Composti eterociclici, 2 anelli
- Composti eterociclici, anello fuso
- Azoli
- Idrocarburi
- Idrocarburi, ciclici
- Acidi carbossilici
- Idrossi acidi
- Idrocarburi, aromatici
- Composti policiclici
- Imidazoli
- Amides
- Indoli
- Incinta
- In gravidanza
- Steroidi
- Composti anelli fusi
- Steroidi, fluorurati
- Fenoli
- Derivati di benzene
- Acidi solfonici
- Acidi zolfo
- Incintadienetrioli
- Acidi, carbociclico
- Benzenesolfonati
- Arilsulfonati
- Acidi arilsolfonici
- para-aminobenzoati
- Aminobenzoati
- Benzoati
- Idrossibenzoati
- Composti eterociclici, 3 anelli
- Fenil eteri
- Benzamidi
- Clorobenzoati
- Carbazoli
- Eteri idrossibenzoato
- Desametasone
- Ondansetrone
- Metoclopramide
- Dobesilato di calcio
- desametasone acetato
Altri numeri di identificazione dello studio
- 48/ERC/FMU/2025-26/343
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