Title: Comparative Study on the Effectiveness of Granisetron and Metoclopramide for Reducing Propofol Injection Pain
Authors: Dr Aravind Johnson, Dr Harikrishnan S, Dr Radhika Devi B
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.163
Abstract
Background: Propofol is one of the widely used intravenousanaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. The aim of my randomized double blinded study was to compare the effectiveness of Granisetron and Metoclopramide in reducing Propofol injection pain. Both these drugs are used as anti emetic drugs. This study also compares the effectiveness of Granisetron and Metoclopramide in reducing post operative nausea and vomiting.
Methods: 760 patients, aged 21-50 years ,American society of Anaesthesiologists grading (ASA) 1-2, scheduled for various surgeries under general anaesthesia were randomly assigned to one of two groups (380 in each group) . One group (Group A) received 2ml Granisetron (1mg/ml) while the other group (Group B) received 2ml Metoclopramide (5mg/ml) and were accompanied by manual venous occlusion for one minute. Then 2ml Propofol was injected through the same cannula. Patients were asked by a blinded anaesthesiologist to score pain on injection of Propofol with a four point scale (VRS-Verbal Rating Scale) : 0= no pain, 1= mild pain, 2=moderate pain, 3=severe pain. The Post operative nausea/vomiting was assessed by Visual Analog Scale (0=no symptoms , 10=worst symptoms)
Results: 65 patients (17.1%) complained of pain in group pretreatedwith Granisetron that is 31 patients (8.1%) with mild pain (VRS 1), 20 patients (5.3%) with moderate pain (VRS 2), 14 patients (3.7%) with severe pain (VRS 3). 151 patients (39.7%) complained of pain in group pretreated with Metoclopramide that is is 76 patients (20%) with mild Pain (VRS 1), 57 patients (15%) with moderate pain (VRS 2) , 18 patients (4.7%) with severe pain (VRS 3). The presence and severity of pain was less in the Granisetron group compared with Metoclopramide group (P< 0.05 ).
In Granisetron group, 41 patients (10.8%) complained of post operative nausea /vomiting that is 38 (10%) had VAS score 1, 2 (0.5%) had VAS score 2, 1 (0.3%) had VAS score 1. In Metoclopramide group, 112 patients (29.5%) complained of post operative nausea /vomiting that is 76 (20%) had VAS score 1, 19 (5%) had VAS score 2, 17 (4.5%) had VAS score 3. The presence and severity of post operative nausea and vomiting was less in the Granisetron group compared with Metoclopramide group (P<0.05).
Conclusion: Intravenous Granisetron at a dose of 2mg was moreeffective than intravenous Metoclopramide at a dose of 10 mg along with manual occlusion for one minute in reducing Propofol injection pain when given before propofol injection. Also, Granisetron was more effective than Metoclopramide in reducing post operative nausea and vomiting.
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