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Comparison of the Effects of Neostigmine-Glycopyrrolate Versus Edrophonium-Atropine on the Incidence of Postoperative Nausea and Vomiting

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Rept. for NOv 1996-Oct 1997

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In this prospective, randomized, double-blind study, investigators compared the incidence of postoperative nausea and vomiting P0NV seen with neostigmine-glycopyrrolate versus edrophonium-atropine when used to reverse neuromuscular block. Forty-two American Society of Anesthesiologist ASA I or II women presenting for elective laparoscopy were randomly administered either neostigmine-glycopyrrolate Group I or edrophonium-atropine Group II at the end of surgery to reverse their neuromuscular block. The anesthetic regime was otherwise the same for both groups. Data collection began upon extubation and ended 12 hours later. Statistical analysis consisted of one-way AN0VA, Fishers exact test, and Pearsons r. The significance level chosen was p 0.05. Demographic characteristics were similar in both groups. Both groups experienced similar incidences of P0NV and antiemetic rescue therapy use. Patients in Group I took an average of 46 minutes longer than patients in Group II to meet ASC discharge criteria p 0.04. A significant correlation was noted between Asian race n3 and PONV in the PACU pO.OOl and in the ASC p0.00l. Hispanic race n3 was positively associated with antiemetic rescue therapy use in the PACU. A history of motion sickness was positively correlated with P0NV in the ASC p 0.05. Neostigmine when combined with atropine has been observed to be associated with a significantly higher incidence of P0NV than edrophonium atropine. Neostigmine has a longer duration of action than atropine which may be responsible for a greater incidence of muscarinic side effects seen when these two drugs are used in combination. Neostigmine and glycopyrrolate share similar onsets and durations as do edrophonium and atropine. This ma account for the lack of a significant difference in the incidence of P0NV seen between the two drug combinations in this study. Alternatively, a Type II error can not be ruled Out due to the studys small sample size. It 7

Subject Categories:

  • Biochemistry
  • Medicine and Medical Research

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