Comparison of the effect of ephedrine, ketamine, ondansetron and atropine drugs to prevent nausea and vomiting during and after surgery in patients under spinal anesthesia for lower limb fracture repair

The effect of ephedrine, ketamine, ondansetron and atropine on nausea and vomiting during and after surgery under spinal anesthesia.

Clinical trial, with parallel groups, double-blind, randomized, phase 2-3 on 128 patients, the patients were randomized based on the block random pattern.

Patients are hospitalized for at least one day before surgery and will fast for 8 hours. Upon entering the operating room, an intravenous line is established for the patient and through it they receive 10 ml per kg of Ringer's serum. Before the spinal anesthesia, the patients will receive 4 groups of medicine. In order to equalize the volume of intervention medicine in all groups, after calculating the desired dose, it will be brought to 5 ml with distilled water and administered intravenously. The frequency and severity of nausea and vomiting, the degree of sedation and the amount of metoclopyramide will be recorded by the student. The study will be designed in a double-blind manner.The patient, the data recorder, and the analyst will not know about the grouping.

Inclusion cditeria: age 18-75 years ohd; both genders; ASA class 1 and 2; lower limb fracture repair surgery under spinal anesthesia. Failure to enter: history of drug addiction; history of allergies: neuromuscular diseases: cardiomyopathy: coagulation disease: underlying disease.

Group 1: 5 mg of ephedrine. Group 2: 100 micrograms of atropine. Group 3: 8 mg of ondansetron. Group 4: Ketamine at the rate of 0.3 mg per kg

Vomiting score in recovery, 2, 4, 6, 12, and 24 hours after surgery Occurrence of nausea during recovery, 2, 4, 6, 12, and 24 hours after surgery. Severity of nausea during recovery, 2, 4, 6, 12, and 24 hours after surgery RAMSAY score in recovery and 1, 2 and 4 hours after the operation Taking Metoclopyramide within 24 hours

Patients will be divided into 4 groups based on the balanced block randomization pattern and the size of the blocks will be 8. The randomization is done by the consultant professor using the online program at https://www.sealedenvelope.com/. Hiding the random chain is done by the method of opaque envelopes.

The study will be designed in a double-blind manner. The method of blinding is that the anesthesiologist prepares the drugs and the anesthetist performs the spinal anesthesia. A student who is responsible for recording information in certain time intervals. Also, the groups are sent to the statistician using coding, and the analyst does not know about the grouping.