Rabiul,

It would be useful to know what types of surgeries and the surgical population demographics. But without that information I can share the preemptive (inexpensive) medications we use: diphenhydramine (12.5 -25 mgs) dexamethasone 4-8mgs) and haloperidol (1-2mgs). I hope you find this information helpful.

Regards,

Christopher

Vomiting is a side effect correlated with infusion time (pharmacokinetic) in most cases while using iv. Prolonged infusion time ( over 30 min) minimizes that side effect.

Very simple. Add metoclopramide 10 mg to the saline (+ tramadol 100 mg) infusion and infuse in 15-30 minutes. ONDANSATRON is expensive and with questionable rationale for this use. An excellent alternative would be a continues IV infusion (eg. Elastomeric pump or PCA: 100 ml of saline + tramadolo 400mg + metoclopramide 40 mg at an infusion rate of 2 ml/hour). Best regards

Dear Christopher, Charalampos and Boaz,

Greetings and thanks.

Your valuable suggestions/alternatives/remedies are quite useful and will help me a lot to reduce patients' discomforts indeed.

Regards- Rabiul.

I am agree with above variants. Also possible and effective will be i.v. 10 mg Metoclopramide before the administration of Tramadol 100 mg in 100 ml saline i.v. in 30 min.

We use metoclopramide 10 mg in association with tramadol 100 mg in 100 ml saline slowly, without problems of nausea and vomiting.

Metoclopramide in my opinion is more efficacious than dolasetron or ondansetron.

Thanks.

We are now following this technique, and getting advantages too.

I think that when we ask questions like this,it's very easy to get a series of different recipes,all of which may produce similar efficacy in preventing nausea and vomiting.

We use a protocol which begins with Ondansetron(4mg),and escalates toadd n Cyclizine(50mg),and has Droperidol(0.625mg) as a final step,+/- Dexamethasone at the beginning.

I think that what's really important is having a combination of drugs to use and an escalation pathway,plus review and audit.