Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study

Abstract Backgrounds Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). Methods Two separate 4-year periods (2007-2010, P1, and (2015-2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. Results A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9±1.5 mg in P1 to 3.5 ± 1.5 mg in P2 (p < 0.0001). Discussion The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB nº 92012/33465

Impact of extending prevention of postoperative nausea and vomiting for cancer surgical patients in the PACU: a before and after retrospective study.

BACKGROUNDS: Procedures for Postoperative Nausea and Vomiting (PONV) prevention are mostly based on identification of the risk factors before administering antiemetic drugs. The purpose of this study was to evaluate the impact of the extended use of antiemetic on the PONV in the Postanesthetic Care Unit (PACU). METHODS: Two separate 4-year periods (2007...2010, P1, and (2015...2018, P2) were evaluated. During P1, the protocol consisted of dexamethasone and droperidol for patients with a locally adapted high PONV score, followed by ondansetron for rescue in the PACU. For Period 2, dexamethasone (8 mg) and ondansetron (4 mg) were administered in patients under general or regional anesthesia, or sedation longer than 30 minutes, while droperidol (1.25 mg) in rescue was injected in cases of PONV in the PACU. An Anesthesia Information Management System was used to evaluate the intensity score of PONV (1 to 5), putative compliance, sedation, and perioperative opioid consumption upon arrival in the PACU. RESULTS: A total of 27,602 patients were assessed in P1 and 36,100 in P2. The administration of dexamethasone and ondansetron increased several fold (p < 0.0001). The high PONV scores were more improved in P2 than in P1, with scores (3+4+5) for P1 vs. P2, p < 0.0001. Overall, 99.7% of the patients in P2 were asymptomatic at discharge. Morphine consumption decreased from 6.9..1.5 mg in P1 to 3.5 .. 1.5 mg in P2 (p < 0.0001). DISCUSSION: The extension of pharmacological prevention of PONV was associated with a decrease in the intensity of severe PONV. However, uncertainty regarding confounding factors should not be ignored. IRB: n.. 92012/33465.

Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus / Comparação dos efeitos profiláticos do droperidol e do ondansetron sobre o prurido provocado pela morfina subaracnoidea / Comparación de los efectos profilácticos del droperidol y del ondansetrón sobre el prurito provocado por la morfina subaracnoidea

The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus.

O efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea.

El efecto profiláctico del ondansetrón sobre el prurito provocado por la morfina subaracnoidea es controvertido, mientras las evidencias nos muestran que el droperidol previene el prurito. El objetivo del presente trabajo es comparar el efecto del droperidol con el del ondansetrón sobre el prurito provocado por la morfina subaracnoidea.

Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus.

BACKGROUND AND OBJECTIVES: The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. METHODS: 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I - control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. RESULTS: Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively. CONCLUSIONS: Ondansetron does not inhibit subarachnoid morphine-induced pruritus.

Estudo comparativo de antieméticos e suas associações, na prevenção de náuseas e vômitos pós-operatórios, em pacientes submetidas a procedimentos cirúrgicos ginecológicos / Estudio comparativo de antieméticos y sus asociaciones, en la prevención de náusea y vómito postoperatorios, en pacientes sometidas a procedimientos quirúrgicos ginecológicos / Comparative study of anti-emetics and their association, in the prevention of postoperative nausea and vomiting in patients undergoing gynecologic surgeries

JUSTIFICATIVA E OBJETIVOS: A profilaxia de náuseas e vômitos pós-operatórios foi objeto de muitos estudos. O objetivo desta pesquisa foi comparar antieméticos e associações na prevenção de náuseas e vômitos pós-operatórios. MÉTODO: Setenta pacientes, ASA I e II, foram submetidas a procedimentos cirúrgicos ginecológicos, sob bloqueio peridural associado à anestesia geral. No Grupo Metoclopramida (GM), administrou-se 20 mg; no Grupo Dexametasona (GDe), injetou-se 8 mg; no Grupo Droperidol (GDr) administrou-se 1,25 mg; no Grupo Ondansetron (GO) injetou-se 8 mg; no Grupo Dexametasona-Ondansetron (GDeO) administrou-se, respectivamente, 8 mg e 4 mg; no Grupo Droperidol-Ondansetron (GDrO) injetou-se 1,25 mg e 4 mg; no Grupo Dexametasona-Droperidol-Ondansetron (GDeDrO) administrou-se 8 mg, 0,625 mg e 4 mg. A presença de náuseas e vômitos foi observada nos momentos de 6, 12, 24 e 36 horas após o término do ato operatório. RESULTADOS: A incidência total de episódios de náuseas foi de quatro no GDeDrO, seis no GO, seis no GDrO, 11 no GDe, 11 no GDeO, 18 no GM e 22 no GDr. Aplicando-se o teste do Qui-quadrado ou o teste de Fisher, ocorreu diferença estatística significativa entre o GDr e os grupos GDe, GDO, GDrO, GDeO, GDeDrO; entre o GM e os grupos GO, GDrO e GDeDrO; entre o GDeO e o grupo GDeDrO. A incidência total de episódios de vômitos foi de três no GO, três no GDeDrO, seis no GDrO, sete no GDe, sete no GDeO, desz no GDr e 13 no G. Verificou-se diferença estatística significativa entre o GDr e os grupos GO e GDeDrO; entre o GM e os grupos GO e GDeDrO. CONCLUSÕES: A associação dexametasona-droperidol-ondansetron e o ondansetron foram mais eficazes na profilaxia de náuseas e vômitos.

BACKGROUND AND OBJECTIVES: Prophylaxis of postoperative nausea and vomiting has been the subject of several studies. The objective of the present study was to compare anti-emetics, and their association, in the prevention of postoperative nausea and vomiting. METHODS: Seventy patients, ASA I and II, underwent epidural block associated with general anesthesia for gynecologic surgeries. Patients in the Metochlopramide Group (MG) received 20 mg of the drug; the Dexamethasone Group (DeG) received 8 mg; the Droperidol Group (DrG) received 1.25 mg; the Ondansetron Group (OG) received 8 mg; the Dexamethasone-Ondansetron Group (DeOG) received 8 mg and 4 mg, respectively; the Droperidol-Ondansetron Group (DrOG) received 1.25 mg and 4 mg, respectively; the Dexamethasone-Droperidol-Ondansetron Group (DeDrOG) received 8 mg, 0.625 mg, and 4 mg. The presence of nausea and vomiting was evaluated at 6, 12, 24, and 36 hours after the end of the surgery. RESULTS: The total incidence of episodes of nausea per group is as follows: 4 in DeDrOG, 6 in OG, 6 in DrOG, 11 in DeG, 11 in DeOG, 18 in MG, and 22 in DrG. The Chi-square and Fisher exact tests indicated statistically significant differences between DrG and DeG, DOG, DrOG, DeOG, and DeDrOG; between MG and OG, DrOG, and DeDrOG; and between DeOG and DeDrOG. And the incidence of vomiting was: 3 in OG, 3 in DeDrOG, 6 in DrOG, 7 in DeG, 7 in DeOG, and 10 in DrG, and 13 in G. There was a statistically significant difference between DrG and OG and DeDrOG; and between MG and OG and DeDrOG. CONCLUSIONS: The association dexamethasone-droperidol-ondansetron and ondansetron alone were more effective in the prophylaxis of nausea and vomiting.

JUSTIFICATIVA Y OBJETIVOS: La profilaxis de náusea y vómito postoperatorios fue objeto de muchos estudios. El objetivo de esta investigación fue comparar antieméticos y asociaciones en la prevención de náusea y vómito postoperatorios. MÉTODO: Setenta pacientes, ASA I y II, fueron sometidas a procedimientos quirúrgicos ginecológicos, bajo bloqueo epidural asociado a la anestesia general. En el Grupo Metoclopramida (GM), se administró 20 mg; en el Grupo Dexametasona (GDe), se inyectó 8 mg; en el Grupo Droperidol (GDr) se administró 1,25 mg; en el Grupo Ondansetron (GO) se inyectó 8mg; en el Grupo Dexametasona-Ondansetron (GDeO) se administró respectivamente 8 mg y 4mg; en el Grupo Droperidol-Ondansetron (GDrO) se inyectó 1,25 mg y 4 mg; en el Grupo Dexametasona-Droperidol-Ondansetron (GDeDrO) se administró 8mg, 0,625 mg y 4mg. La presencia de náuseas y vómitos fue observada en los momentos de 6, 12, 24 y 36 horas después del término de la operación. RESULTADOS: La incidencia total de episodios de náuseas fue de 4 en el GDeDrO, 6 en el GO, 6 en el GDrO, 11 en el GDe, 11 en el GDeO, 18 en el GM y 22 en el GDr. Al aplicar el test del Chi-cuadrado o el test de Fisher, se comprobó la diferencia estadística significativa entre el GDr y los grupos GDe, GDO, GDrO, GDeO, GDeDrO; entre el GM y los grupos GO, GDrO y GDeDrO; entre el GDeO y el grupo GDeDrO. La incidencia total de episodios de vómitos fue de 3 en el GO, 3 en el GDeDrO, 6 en el GDrO, 7 en el GDe, 7 en el GDeO, 10 en el GDr y 13 en el G. Se comprobó así mismo, la diferencia estadística significativa entre el GDr y los grupos GO y GDeDrO; entre el GM y los grupos GO y GDeDrO. CONCLUSIONES: La asociación dexametasona-droperidol-ondansetron y el ondansetron fueron más eficaces en la profilaxis de náuseas y vómitos.

Profilaxia antiemética em cirurgia de abdome agudo: estudo comparativo entre droperidol, metoclopramida, tropisetron, granisetron e dexametasona / Prophylactic antiemetic therapy for acute abdominal surgery: a comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone

JUSTIFICATIVA E OBJETIVOS: A incidência de náuseas e vômitos pós-operatórios (NVPO) gira em torno de 30 por cento. A profilaxia de NVPO foi objeto de múltiplos estudos, tanto para tentar diminuir esse problema como para comparar o índice custo-benefício do tratamento utilizado. Esse estudo comparou a eficácia de cinco fármacos antieméticos em apendicectomia. MÉTODO: Estudo clínico prospectivo controlado, duplamente encoberto de 150 pacientes ASA I e II com IMC < 30, submetidos a apendicectomia. Os pacientes foram divididos em seis grupos: Grupo 1 (n = 25): 5 mL solução fisiológica a 0,9 por cento; Grupo 2 (n = 25): droperidol 0,625 mg; Grupo 3 (n = 25): metoclopramida 20 mg; Grupo 4 (n = 25): tropisetron 5 mg; Grupo 5 (n = 25): granisetron 1 mg; Grupo 6 (n = 25): dexametasona 4 mg. A monitoração foi realizada com ECG, PANI, SpO2, P ET CO2, analisador de gases anestésicos e estimulador de nervo periférico. Foi avaliada a presença de NVPO, complicações e o grau de satisfação nas primeiras 48 horas. RESULTADOS: O droperidol apresentou incidência 4 por cento de NVPO, os grupos de granisetron, tropisetron e metoclopramida apresentaram 12 por cento de NVPO (p < 0,05). O grupo de dexametasona apresentou 24 por cento e o controle 28 por cento de NVPO. CONCLUSÕES: Na profilaxia de NVPO em apendicectomia de urgência o uso de baixas doses de droperidol foi mais efetivo que o dos outros fármacos.

BACKGROUND AND OBJECTIVES: It is calculated that the incidence of postoperative nausea and vomiting (PONV) is approximately 30 percent. The prophylaxis of PONV has been the subject of several studies, both to decrease this problem and to compare the cost-benefit ration of the treatment used. The objective of this study was to compare the efficacy of 5 antiemetic drugs with a control group in emergency appendectomy. METHODS: A controlled, double-blind, prospective study with 150 patients, ASA I and II, BMI < 30, undergoing appendectomy, was undertaken. Patients were divided in six groups: Group 1 (n = 25): 5 mL of normal saline; Group 2 (n = 25): 0.625 mg of droperidol; Group 3 (n = 25): 20 mg of metoclopramide; Group 4 (n = 25): 5 mg of tropisetron; Group 5 (n = 25): 1 mg of granisetron; Group 6 (n = 25): 4 mg of dexamethasone. Monitoring included ECG, non-invasive blood pressure, O2 saturation, P ET CO2, anesthetic gas analyzer and peripheral nerve stimulator. The presence of PONV, complications and the degree of satisfaction in the first 48 hours were evaluated. RESULTS: The incidence of PONV in the droperidol group was 4 percent while in the granisetron, tropisetron and metoclopramide groups it was 12 percent (p < 0.05). The dexamethasone group had a 24 percent incidence and the control group 28 percent. CONCLUSIONS: Low doses of droperidol were more effective in the prophylaxis of PONV in emergency appendectomy than the other drugs.

JUSTIFICATIVA Y OBJETIVOS: La incidencia de náuseas y vómitos peri operatorios (NVPO) se estima en un 30 por ciento. La profilaxis de NVPO ha sido objetivo de múltiples estudios, tanto para intentar disminuir este problema como a su vez comparar índice costo-beneficio de la terapia utilizada. Este estudio evalúa la utilización de 5 fármacos antieméticos en relación a grupo control para apendicectomía de urgencia. MÉTODO: Estudio clínico prospectivo controlado, doble ciego de 150 pacientes ASA I y II con IMC < 30, beneficiarios de apendicectomía. Los pacientes fueron divididos en seis grupos: Grupo 1 (n = 25): 5 ml solución salina; Grupo 2 (n = 25): droperidol 0,625 mg; Grupo 3 (n = 25): metoclopramida 20 mg; Grupo 4 (n = 25): tropisetrón 5 mg; Grupo 5 (n = 25): granisetrón 1 mg; Grupo 6 (n = 25): dexametasona 4 mg. El monitoreo se realizó con ECG, NIBP, SATO2, P ET CO2, analizador de gases anestésicos y ENP. Se evaluó la presencia de NVPO, complicaciones y grado de satisfacción en las primeras 48 horas. RESULTADOS: Droperidol presentó un 4,0 por ciento de NVPO en comparación con los grupos de granisetrón, tropisetrón y metoclopramida que presentaron un 12,0 por ciento de NVPO (p < 0,05). El grupo de dexametasona presento 24,0 por ciento y el control un 28,0 por ciento de NVPO. CONCLUSIONES: En la profilaxis para NVPO en la apendicectomía de urgencia se muestra más efectivo el uso de dosis bajas de droperidol en comparación con otros fármacos.

Prophylactic antiemetic therapy for acute abdominal surgery. A comparative study of droperidol, metoclopramide, tropisetron, granisetron and dexamethasone.

BACKGROUND AND OBJECTIVES: It is calculated that the incidence of postoperative nausea and vomiting (PONV) is approximately 30%. The prophylaxis of PONV has been the subject of several studies, both to decrease this problem and to compare the cost-benefit ration of the treatment used. The objective of this study was to compare the efficacy of 5 antiemetic drugs with a control group in emergency appendectomy. METHODS: A controlled, double-blind, prospective study with 150 patients, ASA I and II, BMI < 30, undergoing appendectomy, was undertaken. Patients were divided in six groups: Group 1 (n = 25): 5 mL of normal saline; Group 2 (n = 25): 0.625 mg of droperidol; Group 3 (n = 25): 20 mg of metoclopramide; Group 4 (n = 25): 5 mg of tropisetron; Group 5 (n = 25): 1 mg of granisetron; Group 6 (n = 25): 4 mg of dexamethasone. Monitoring included ECG non-invasive blood pressure, O2 saturation, P(ET)CO2, anesthetic gas analyzer and peripheral nerve stimulator. The presence of PONV complications and the degree of satisfaction in the first 48 hours were evaluated. RESULTS: The incidence of PONV in the droperidol group was 4% while in the granisetron, tropisetron and metoclopramide groups it was 12% (p < 0.05). The dexamethasone group had a 24% incidence and the control group 28%. CONCLUSIONS: Low doses of droperidol were more effective in the prophylaxis of PONV in emergency appendectomy than the other drugs.

Estudio clínico comparativo, randomizado y doble ciego entre droperidol, metoclopramida, tropisetrón, granisetrón y dexametasona para profilaxis antiemética en apendicectomía / Randomized, double blind comparative clinical study between droperidol, metoclopramide, tropisetron, granisetron and dexametasone for antiemetic prophylaxis in appendectomy

Introducción y objetivos: La incidencia de náuseas y vómitos posoperatorios (NVPO) se estima en un 30 por ciento. La profilaxis de NVPO ha sido objetivo de múltiples estudios, tanto para intentar disminuir este problema como para comparar el índice costo-beneficio de la terapia utilizada. En este estudio se compara, evaluando los índices costo/beneficio, la eficacia de cinco fármacos antieméticos utilizados para apendicectomía de urgencia con la de un grupo control. Pacientes y método: Estudio clínico prospectivo controlado, doble ciego, de 150 pacientes ASA I-II con IMC<30, sometidos a apendicectomía. Los pacientes fueron divididos en seis grupos; Grupo 1 (n= 25): 5 ml de solución salina; Grupo 2 (n= 25): droperidol, 0,625 mg; Grupo 3 (n= 25): metoclopramida, 20 mg; Grupo 4 (n= 25): tropisetrón, 5 mg; Grupo 5 (n= 25): granisetrón,1 mg; Grupo 6 (n= 25): dexametasona, 4 mg. El monitoreo se realizó con ECG, NIBP, SATO2, EtCO2, analizador de gases anestésicos y ENP. Se evaluaron: la presencia de NVPO, las complicaciones y el grado de satisfacción en las primeras 48 horas. Resultados: La incidencia de NVPO en el grupo del droperidol fue de un 4,0 por ciento, mientras que en los grupos de granisetrón, tropisetrón y metoclopramida fue de 12,0 por ciento (p < 0.05). En el grupo de la dexametasona y en el de control se observó una incidencia de NVPO de 24,0 y 28,0 por ciento respectivamente. Conclusiones: En la profilaxis para NVPO en apendicectomía de urgencia, el uso de dosis bajas de doperidol es más efectivo que el empleo de otros fármacos, siendo excelente su índice costo-beneficio.

Estudio clínico comparativo, randomizado y doble ciego entre droperidol, metoclopramida, tropisetrón, granisetrón y dexametasona para profilaxis antiemética en apendicectomía / Randomized, double blind comparative clinical study between droperidol, metoclopramide, tropisetron, granisetron and dexametasone for antiemetic prophylaxis in appendectomy

Introducción y objetivos: La incidencia de náuseas y vómitos posoperatorios (NVPO) se estima en un 30 por ciento. La profilaxis de NVPO ha sido objetivo de múltiples estudios, tanto para intentar disminuir este problema como para comparar el índice costo-beneficio de la terapia utilizada. En este estudio se compara, evaluando los índices costo/beneficio, la eficacia de cinco fármacos antieméticos utilizados para apendicectomía de urgencia con la de un grupo control. Pacientes y método: Estudio clínico prospectivo controlado, doble ciego, de 150 pacientes ASA I-II con IMC<30, sometidos a apendicectomía. Los pacientes fueron divididos en seis grupos; Grupo 1 (n= 25): 5 ml de solución salina; Grupo 2 (n= 25): droperidol, 0,625 mg; Grupo 3 (n= 25): metoclopramida, 20 mg; Grupo 4 (n= 25): tropisetrón, 5 mg; Grupo 5 (n= 25): granisetrón,1 mg; Grupo 6 (n= 25): dexametasona, 4 mg. El monitoreo se realizó con ECG, NIBP, SATO2, EtCO2, analizador de gases anestésicos y ENP. Se evaluaron: la presencia de NVPO, las complicaciones y el grado de satisfacción en las primeras 48 horas. Resultados: La incidencia de NVPO en el grupo del droperidol fue de un 4,0 por ciento, mientras que en los grupos de granisetrón, tropisetrón y metoclopramida fue de 12,0 por ciento (p < 0.05). En el grupo de la dexametasona y en el de control se observó una incidencia de NVPO de 24,0 y 28,0 por ciento respectivamente. Conclusiones: En la profilaxis para NVPO en apendicectomía de urgencia, el uso de dosis bajas de doperidol es más efectivo que el empleo de otros fármacos, siendo excelente su índice costo-beneficio. (AU)

[Controlled trial of dexamethasone compared with droperidol and ondansetron for the treatment of postoperative nausea and vomiting]. / Eficacia de la dexametasona en el tratamiento agudo de náuseas y vómitos posoperatorios: comparación con droperidol y ondansetrón.

BACKGROUND: Dexamethasone is useful as prophylaxis for postoperative nausea and vomiting (PONV). AIM: To study the short term efficacy of dexamethasone to treat PONV in adults without prophylaxis, and compare its efficacy with that of droperidol and ondansetron. MATERIAL AND METHODS: A prospective study was performed with 120 consecutive adult patients presenting PONV in the postanesthesia care unit (PACU) at a University teaching hospital. During the occurrence of PONV, patients were randomized to receive in a double blind manner dexamethasone 8 mg IV (Group 1, n=40), droperidol 1.25 mg IV (Group 2, n=40), or ondansetron 2 mg IV (Group 3, n=40). Risk factors for PONV were recorded. Evaluations were made until discharge from the PACU and included presence of PONV, degree of sedation, and other potential adverse effects of the study drugs. Short term efficacy was defined as the percentage of patients free of PONV during all the stay in PACU after treatment. RESULTS: General data was similar for the 3 groups. Mean +/- SD stay in PACU after treatment was 101+/-34 minutes in Group 1, 93+/-33 minutes in Group 2, and 99+/-32 minutes in Group 3 (NS). Short term efficacy (CI 95%) was 55% (40-70%) in Group 1, 90% (81-99%) in Group 2, and 63% (48-78%) in Group 3 (p <0.05 for group 2 vs 1 and 3). There were no adverse effects attributable to the study drugs. CONCLUSIONS: Short term efficacy of dexamethasone to treat PONV was similar to ondansetron, but inferior to droperidol. Further studies are needed to define the duration of this effect of dexamethasone.

Eficacia de la dexametasona en el tratamiento agudo de náuseas y vómitos posoperatorios: Comparación con droperidol y ondansetrón / Controlled trial of dexamethasone compared with droperidol and ondansetron for the treatment of postoperative nausea and vomiting

Background: Dexamethasone is useful as prophylaxis for postoperative nausea and vomiting (PONV). Aim: To study the short term efficacy of dexamethasone to treat PONV in adults without prophylaxis, and compare its efficacy with that of droperidol and ondansetron. Material and methods: A prospective study was performed with 120 consecutive adult patients presenting PONV in the postanesthesia care unit (PACU) at a University teaching hospital. During the occurrence of PONV, patients were randomized to receive in a double blind manner dexamethasone 8 mg IV (Group 1, n=40), droperidol 1.25 mg IV (Group 2, n=40), or ondansetron 2 mg IV (Group 3, n=40). Risk factors for PONV were recorded. Evaluations were made until discharge from the PACU and included presence of PONV, degree of sedation, and other potential adverse effects of the study drugs. Short term efficacy was defined as the percentage of patients free of PONV during all the stay in PACU after treatment. Results: General data was similar for the 3 groups. Mean ± SD stay in PACU after treatment was 101±34 minutes in Group 1, 93±33 minutes in Group 2, and 99±32 minutes in Group 3 (NS). Short term efficacy (CI 95%) was 55% (40-70%) in Group 1, 90% (81-99%) in Group 2, and 63% (48-78%) in Group 3 (p <0.05 for group 2 vs 1 and 3). There were no adverse effects attributable to the study drugs. Conclusions: Short term efficacy of dexamethasone to treat PONV was similar to ondansetron, but inferior to droperidol. Further studies are needed to define the duration of this effect of dexamethasone.

Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus.

BACKGROUND: We have compared the use of alizapride, propofol, droperidol and promethazine for the prevention of spinal morphine-induced pruritus. METHODS: Three hundred ASA I or II women undergoing Caesarean section under spinal anaesthesia, in which morphine 0.2 mg was added to a local anaesthetic, were assigned randomly to receive i.v., in the operating room, just after delivery of the baby, alizapride 100 mg, propofol 20 mg, droperidol 1.25 mg, promethazine 50 mg or saline 2 ml (control group). In the postoperative period, the women were assessed for pruritus (absent, mild, moderate or severe) or other untoward symptoms by blinded observers. We used 95% confidence limits (95% CI) for the cumulative incidence of moderate and severe pruritus to compare the groups, and the NNT and 95% CI to compare droperidol, propofol and alizapride as for their effectiveness in preventing pruritus. For other untoward effects, the chi(2)-test was used, results being considered significant when P<0.05. RESULTS: The droperidol, propofol and alizapride groups had significantly lower incidences of pruritus compared with the control and promethazine groups, while the incidence of pruritus was similar among the patients assigned to the promethazine and control groups. As for the prevention of moderate and severe pruritus, droperidol had the lowest NNT (3.52; 95% CI: 3.37-3.67), followed by propofol (4.61; 95% CI: 4.45-4.77) and alizapride (5.43; 95% CI: 5.27-5.59). As for untoward effects, droperidol and promethazine increased the incidence of somnolence, which seemed more severe with promethazine. Otherwise, there were no differences between the groups. CONCLUSION: Droperidol, propofol and alizapride, in a decreasing order of effectiveness in the doses used in this study, reduced the incidence of pruritus induced by the use of morphine 0.2 mg intrathecally. On the other hand, promethazine 50 mg was shown to be ineffective.

Profilaxia do prurido causado pela administração subaracnóidea de sufentanil: efeitos do droperidol, da nalbufina, do ondansetron e da combinação deles / Prophylaxis of pruritus caused by subarachnoid administration of sufentanil: effects of droperidol, nalbuphine, ondansetron and their combination

JUSTIFICATIVA E OBJETIVOS: O uso espinhal de opióides pode causar alguns efeitos indesejáveis, dentre os quais, o mais freqüente é o prurido que, apesar de sua baixa morbidade, pode proporcionar desconforto intenso ao paciente e prolongar o período de internação. O objetivo deste estudo foi avaliar diversas opções terapêuticas no tratamento profilático do prurido após administração de sufentanil por via subaracnóidea. MÉTODO: Foram distribuídos de maneira aleatória, por sorteio, 100 pacientes a serem submetidos à intervenção cirúrgica não-obstétricas em cinco grupos, de acordo com o tratamento utilizado: controle (ausência de tratamento - C); droperidol 2,5 mg (D); nalbufina 10 mg (N); associação dos medicamentos anteriores (DN) e ondansetron 8 mg (O). O prurido foi avaliado quantitativamente 30 minutos, 1, 2, e 3 horas após a administração subaracnóidea de sufentanil. RESULTADOS: Os grupos C e O apresentaram incidência significativamente maior de prurido em relação aos grupos D, N e DN. Entretanto, não houve diferença significativa na necessidade de tratamento específico com naloxona entre os grupos tratados. CONCLUSÕES: O tratamento profilático do prurido neste estudo, independentemente do fármaco utilizado, diminuiu sua intensidade e limitou a necessidade de tratamento específico com naloxona.

Efficacy of prophylactic droperidol, ondansetron or both in the prevention of postoperative nausea and vomiting in major gynaecological surgery. A prospective, randomized, double-blind clinical trial.

We conducted a prospective, randomized, double-blind clinical trial comparing droperidol 1.25 mg intravenously (i.v.) (group 1, n = 30), ondansetron 4 mg i.v. (group 2, n = 30), or both (group 3, n = 30) in the prevention of postoperative nausea and vomiting (PONV) in the first 24 h following major gynaecological procedures under combined general and epidural anaesthesia. PONV was analysed by a linear nausea/vomiting score, incidence of nausea and vomiting, and the need for antiemetic rescue. Our results showed a similar incidence of nausea and vomiting in all groups (G1 33%, G2 40%, G3 43%). However, when comparisons were made according to the time of assessment, combination therapy resulted in significantly lower PONV than droperidol in the first hour (0% vs. 13%, P < 0.05) and second hour (0% vs. 13%, P < 0.05), and than ondansetron on the first hour (0% vs. 13%, P < 0.05). A trend persisted up to the fourth hour but was not statistically significant in either group. In conclusion, droperidol and ondansetron are effective agents in the prevention of PONV, and their combination seems to provide slightly better results than either drug alone.

The inhibition of epidural morphine-induced pruritus by epidural droperidol.

UNLABELLED: IV droperidol inhibits epidural morphine-induced pruritus, but this effect disappears when the dose is increased from 2.5 to 5.0 mg. This study was performed to determine whether epidural droperidol would have a similar effect. In this double-blinded study, we enrolled 140 patients undergoing Cesarean delivery under epidural anesthesia who were randomly allocated to four groups. Anesthesia consisted of 150 mg of 0.5% bupivacaine with 1:200,000 epinephrine, with 2 mg of morphine and 0.0, 1.25, 2.5, or 5.0 mg of droperidol (Groups 1 to 4). During the postoperative period, patients were assessed for pruritus (absent, mild, moderate, or severe) and other untoward symptoms. The chi(2) test was used to compare the incidence of the side effects. For the analysis of pruritus, we used the Mantel-Haenszel test for linear association. Droperidol induced a dose-related reduction in the incidence of pruritus (P < 0.001). This reduction was independent of the incidence of somnolence, which increased with droperidol dose (P < 0.05 when the incidence of somnolence in Groups 1 and 4 was compared). We conclude that droperidol, in doses up to 5 mg epidurally, induces a dose-related reduction in the incidence of pruritus without inducing significant side effects. IMPLICATIONS: Epidural morphine is effective for pain control but yields some side effects, including pruritus, that can be severe. Studying patients undergoing Cesarean delivery, we found a dose-related reduction in the incidence of pruritus using epidural droperidol.

Ondansetron and droperidol in the prevention of postoperative nausea and vomiting.

We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. Shortly before induction of anaesthesia, patients received: saline i.v. (group I, n = 62); droperidol 2.5 mg i.v. (group 2, n = 60); ondansetron 4 mg i.v. (group 3, n = 57); or droperidol 2.5 mg with ondansetron 4 mg i.v. (group 4, n = 63). Nausea occurred in 45%, 37%, 32% and 29% (P = 0.234) and vomiting in 23%, 17%, 9% and 5% (P = 0.016) of patients in groups 1, 2, 3 and 4, respectively, during the first 24 h. Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P < 0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.

Inhibition of epidural morphine-induced pruritus by intravenous droperidol. The effect of increasing the doses of morphine and of droperidol.

BACKGROUND AND OBJECTIVES: Because the mechanism of inhibition of epidural morphine-induced pruritus by droperidol is not clear, this study was undertaken to determine the effects of larger doses of droperidol or morphine, or both. METHODS: A double-blind study was performed in 210 ASA I or II patients undergoing cesarean delivery, who were randomly assigned to six groups. All patients received epidural anesthesia with 0.5% bupivacaine containing 1:200,000 epinephrine, to which 2 mg (groups 1, 2, and 3) or 4 mg (groups 4, 5, and 6) morphine sulfate was added. Just after delivery, 2.5 mg droperidol was given intravenously to groups 2 and 5, and 5 mg was given to groups 3 and 6. During the postoperative period, the patients were assessed for the occurrence and severity of pruritus (classified as absent, mild, moderate, or severe) or other untoward symptoms. The groups were compared for the incidence of pruritus by the Mann-Whitney nonparametric test. RESULTS: The incidence of pruritus was significantly reduced only when the control group. (no droperidol) was compared with the group that received 2.5 mg droperidol, both when 2 mg and when 4 mg morphine was used. A 5-mg dose of droperidol had no inhibitory effect. There was no difference in the incidence of pruritus between use of 2 mg and 4 mg morphine. Other untoward effects of morphine either could not be observed or occurred with an incidence unaffected by either dose of droperidol. CONCLUSION: Pruritus caused by epidural use of 2 or 4 mg of morphine is inhibited by the intravenous use of 2.5 mg droperidol but not by a larger dose.

Inhibition of epidural morphine-induced pruritus by intravenous droperidol.

BACKGROUND AND OBJECTIVES: Our objective was to study in more detail our previous finding that intravenous droperidol inhibits pruritus induced by epidural morphine. METHODS: In a double blind study, 107 ASA I or II patients undergoing cesarean section received epidural anesthesia with 150 mg (30 ml) of 0.5% bupivacaine with 1:200,000 epinephrine and 2 mg of morphine hydrochloride in a single injection. They were randomly allocated to either receive (treated group, n = 54) or not receive (control group, n = 53) an intravenous injection of 2.5 mg of droperidol just after delivery. During the postoperative period, the patients were assessed for the occurrence and severity of pruritus or other possible untoward symptoms. Pruritus was classified as absent, mild, moderate, or severe. RESULTS: The incidence of pruritus in control group was absent, 26.4%; mild, 39.6%; moderate, 28.3%; severe, 5.7%; for the treated group, the incidences were, respectively: 59.2; 27.8; 13.0; and 0.0% (p = 0.0003; Mann-Whitney test). As for other side effects of morphine, nausea and vomiting had a similar incidence in the two groups; urinary retention could not be analyzed because of bladder catheterization, and constipation, herpes labialis and clinical evidence of respiratory depression were never observed. Droperidol produced a greater incidence of somnolence (2% in control and 17% in treated group--p < 0.02; Fisher's exact test), but it was never incapacitating. The incidence of hypotension was similar in the two groups. CONCLUSION: Intravenous droperidol reduces the incidence and severity of pruritus caused by epidural injection of morphine without inducing important side effects.

Efecto antiemético del Droperidol: en colecistectomías electivas por laparotomía / The antiemetic effect of doperidol: in elective cholecystectomy by laparotomy

La cirugía biliar se asocia a una alta incidencia de emesis postoperatoria, que es molesta y tiene riesgos. Creemos que el droperidol podría disminuirla. Objetivos: evaluar la utilidad del Droperidol como antimético al administrarlo profilácticamente en colecistectomías por laparotomía. Materiales y métodos. Estudiamos en forma prospectiva, aleatoria y doble ciego la incidencia de náuseas y vómitos en 102 adultos sometidos a colecistectomía electiva por laparotomía. Luego de la inducción, el grupo I recibieron morfina (n=52) recibió Droperidol 20 µgxKg ev y el grupo II (n=50) placebo. En el postoperatorio los pacientes morfina y clonixino como analgésicos y evaluamos la presencia de náuseas, vómitos, grado de sedación e intensidad del dolor a las 2,4,6,9,12 y 24 horas. Resultados: no hubo diferencias demográficas entre los grupos. A las 24 horas la incidencia de náuseas y vómitos fue 42 por ciento en el grupo I y 62 por ciento en el grupo II (p=0,0466). Los pacientes del grupo I presentaron menos dolor aunque recibieron igual cantidad de analgésicos. Conclusiones: El Droperidol es un antiemético útil en colecistectomías electivas y su uso parece potenciar la analgesia postoperatoria