Oral Mosapride Can Provide Additional Antiemetic Efficacy Following Total Joint Arthroplasty Under General Anesthesia

A Randomized, Double-blinded Clinical Trial

Jinwei Xie; Yingchun Cai; Jun Ma; Qiang Huang; Fuxing Pei

Disclosures

BMC Anesthesiol. 2020;20(297) 

In This Article

Results

A total of 82 patients were initially allocated to each of the three groups. We excluded two patients from the control group and four from the Mosa+Dexa group because of incomplete data and spinal anesthesia. In the end, 240 patients (80 in the control group, 82 in the Dexa group and 78 in the Mosa+Dexa group) were included in the final analysis (Figure 1). These groups showed no significant differences in clinical or demographic characteristics (Table 1).

Figure 1.

A flow diagram shows the patients recruitment

Prophylactic use of concurrent dexamethasone and oral mosapride reduced the overall incidence and severity of PONV, and improved the overall complete response during the entire 48-h evaluation period. Across the entire evaluation period, incidence of postoperative nausea was lowest in the Mosa+Dexa group (6.4%), followed by the Dexa group (19.5%) and the control group (43.8%) (p < 0.01 for all, Table 2). Similarly, incidence of postoperative vomiting was lowest in the Mosa+Dexa group (3.9%), followed by the Dexa group (6.1%) and the control group (11.2%), although these differences were not significant (p = 0.176). The rate of complete response was significantly higher in the Mosa+Dexa group (89.7%) than in the Dexa group (74.4%, p = 0.012) or control group (45%, p < 0.001). The rate of severe PONV was significantly lower in the Mosa+Dexa group (1.3%) than in the Dexa group (7.3%, p = 0.062) and control group (18.8%, p < 0.001).

Simultaneous application of mosapride and dexamethasone reduced the incidence of nausea mainly during the first 12 h (Table 3 and Table 4): the incidence during 6–12 h was significantly lower in the Mosa+Dexa group (3.8%) than in the Dexa group (15.9%, p < 0.016) and control group (32.5%, p < 0.016). Moreover, all vomiting episodes occurred during the first 12 h in the Mosa+Dexa patients, while some vomiting incidents in other groups occurred later (Table 4). Nevertheless, the vomiting incidence during the first 12 h did not differ significantly among the three groups. Less patients in Mosa+ Dexa group (2.6%) required rescue treatment for PONV when compared with Dexa group (9.8%, p = 0.06) and Control group (21.3%, p < 0.001, Table 5), as well as total dose of metoclopramide. No significances were detected among the three groups regarding the postoperative pain score and rescue requirement.

The preemptive use of mosapride also reduced the time until first defecation, which was significantly shorter in the Mosa+Dexa group (36.4 ± 18.3 h) than in the Dexa group (54.7 ± 15.8 h, p < 0.001) and control group (60.7 ± 24.6 h, p < 0.001; Table 6). Appetite score was significantly higher in the Mosa+Dexa group than in the control group on postoperative days 0 (p = 0.019), 1 (p < 0.001) and 2 (p = 0.022); and higher than in the Dexa group on postoperative day 1 (p = 0.001; Table 6). Patients in the Mosa+Dexa group began to ambulate 20.6 ± 5.9 h after surgery, significantly sooner than patients in the Dexa group (23.4 ± 5.8 h, p = 0.005) or control group (23.3 ± 4.6 h, p = 0.008). Patients in the Mosa+Dexa group were more satisfied with their hospital experience than patients in the control group (p < 0.001) and Dexa group (p = 0.008). Length of hospitalization was shorter in the Mosa+Dexa group than in the contrl group (4.9 ± 1.4 vs 5.6 ± 1.5 d, p = 0.012).

No adverse events associated with mosapride including prolonged QT syndrome were observed during the study or follow-up. A total of 5 patients (including 1 abdominal pain, 2 dry mouth, 2 insomnia) experienced side effects in control group, 5 patients (1 diarrhea, 1 dry mouth, 3 insomnia) in Dexa group and 6 (in abdominal pain, 2 dry mouth and 3 insomnia) in Mosa + Dexa group without significance (p = 0.908, Table 7).

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....