Optimal Dose of Granisetron for Prophylaxis Against Postoperative Emesis After Gynecological Surgery

We previously reported that 20 and 40 micro g/kg of granisetron given during anesthesia prevented postoperative emesis with no severe complications.The aim of the current study was to determine the optimal dose of granisetron for the prevention of postoperative nausea and vomiting (PONV) after gynecological surgery. Two hundred female patients (ASA physical status I) were randomly allocated to one of five groups (n = 40 for each): saline (as a control), granisetron 2 micro g/kg, granisetron 5 micro g/kg, granisetron 10 micro g/kg, and granisetron 20 micro g/kg. Saline or granisetron was given intravenously immediately after induction of anesthesia. PONV was assessed 24 h after surgery. The percentage of emesis-free patients was significantly greater in the 5- to 20-micro g/kg granisetron groups than in the control and 2-micro g/kg granisetron groups (18%, 23%, 68%, 78%, and 75% of patients receiving saline or granisetron 2 micro g/kg, 5 micro g/kg, 10 micro g/kg, and 20 micro g/kg, respectively). Granisetron doses of 5 micro g/kg or larger were also superior to the saline and 2-micro g/kg granisetron treatment for the prevention of nausea over the 24-h study period (nausea visual analog scales 24 h after surgery: 49, 41, 18, 16, and 14 mm in the control and granisetron 2 micro g/kg, 5 micro g/kg, 10 micro g/kg, and 20 micro g/kg groups, respectively). A smaller proportion of patients received "rescue" antiemetic in the 5-micro g/kg or larger granisetron groups than in the control and 2-micro g/kg granisetron groups (48%, 40%, 18%, 13%, and 10% of patients in the control and granisetron 2 micro g/kg, 5 micro g/kg, 10 micro g/kg, and 20 micro g/kg groups, respectively). The antiemetic effect of granisetron was similar among the groups who received 5-micro g/kg or larger doses. In conclusion, we suggest that the optimal dose of granisetron is 5 micro g/kg for the prevention of PONV after gynecological surgery. Implications: Nausea and vomiting postoperatively after gynecologic surgery is a significant problem. The authors found that granisetron, a selective antagonist of serotonin, markedly decreases the incidence of postoperative nausea and vomiting at doses of 5 micro g/kg or larger. (Anesth Analg 1997;85:652-6)