Effect of premedication with mirtazapine versus ondansetron on postoperative nausea and vomiting in breast surgery

Background: Mirtazapine is a specific serotonergic antidepressant drug. The aim of this study was to compare the efficacy of mirtazapine as PONV prophylaxis with a classic 5HT3 receptor antagonist; ondansetron. Methods: Eighty female patients with high PONV risk undergoing prophylactic mastectomy with a standardized anesthetic were randomized to receive either an oral disintegrating tablet (ODT) of mirtazapine 30 mg (group M) or ondansetron 16 mg (group O) 1 h before surgery. Preoperative anxiety level was assessed by state and trait anxiety inventory before taking the study drug and 1 h after. Vital sign variables, the incidence of PONV, the use of rescue antiemetic, complete response, postoperative VAS pain scores, the inverted observer's assessment of alertness/ sedation scale and side effects were compared. Results: Mirtazapine premedication reduced preoperative state anxiety inventory scores (P < 0.01) and the incidence of early nausea and late vomiting (P < 0.05). The percentage of patient having complete responses during the first 24 h after anesthesia was 75% after mirtazapine and 65% after ondansetron prophylaxis. Anesthetic requirements, postoperative pain, sedation scores, and side effects were similar between the two groups. Conclusion: Mirtazapine prophylaxis reduces preoperative anxiety and the incidence of postoperative early nausea and late vomiting compared with ondansetron, without untoward sedative or cardiovascular effects. (C) 2011 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B. V.