INTRODUCTION: Ondansetron, a serotonin type (5-HT3) antagonist, has been shown to be effective in the prevention of postoperative nausea and vemiting(PONV) without producing adverse side effects. However ondansetron is expensive compared to older antiemetics like droperidol. Although droperidol is much less expensive, its use has been associated with extrapyramidal side effects and delayed restlessness. The purpose of this study was to compare the prophylatic antiemetic efficacy and side effect profile of ondansetron to various doses of droperidol when administered to women undergoing elective outpatient and inpatient surgical procedure under general anesthesia.
METHODS: After obtaining IRB approval and written informed consent, ASA physical status I and II 100 women scheduled for outpatient gynecologic surgery(e.g., laparoscopy, hysteroscopy, come biopsy, Bartholin cystectomy, D&C) and 120 women patients scheduled for inpatient surgery(e.g., total abdominal hysterectomy) were enrolled in a prospective, double-blind, placebo-controlled trial. The inpatients were randomized to receive intravenous(IV), ondansetron 4 mg, droperidol 0.312 mg, 0.625 mg, 1.25 mg, or saline(placebo) prior to induction of anesthesia. The inpatients were randomized to receive ondansetron 4 mg, droperidol 0.625 mb, 2.5 mg, 5 mg, or saline IV before induction of anesthesia. All patients received a standardized induction technique consisting of midazolam(2 mg), propofol (2 mg/kg), fentanyl (1 microgram/kg) and succinylcholine (1 mg/kg). Anesthesia was maintained with O2(2 L/min)-N2O(3 L/min)- enflurane. Visual analogue scale (VAS scores) for nausea, 0=none to 10=severe, were evaluated postoperatively at 1 hr in the recovery room and at 4 hr after surgery. The occurrence of postoperative complications, including emetic episodes, dizziness, dysphoria and extrapyramidal symptoms, were evaluated at 4~8 hr intervals after surgery. P-values are derived from the Kruskall-Wallis and Chisquare test, with a p-value of less than 0.05 considered statistically significant.
RESULTS: A total of 220 women patients were involved in these two independent studies. There were no significant differences between the treatment groups with respect to age, weight, height, duration of surgery, duration of anesthesia in the two surgical populations. Both ondansetron (4 mg) and droperidol (0.312 to 5.0 mg) were more effective than saline in preventing.PONV(Figures 1 and 2). However there were no differences between the various antiemetic treatment groups. Moreover, prophylactic use of droperidol did not increase postoperative side effects compared to saline or ondansetron.
CONCLUSION: These studies have demonstrated that low doses (0.312 to 1.25 mg IV) of droperidol were as effective as ondansetron, 4 mg IV, in preventing PONV after both outpatient and inpatient gynecologic procedures. Afterinpatient procedures, low doses(0.625 - 1.25 mg IV) of droperidol were more effective than higher doses (>2.5 mg>. These data suggest that a low dose of droperidol is a cost-effective to ondansetron for the prevention of PONV after both outpatient and inpatient gynecologic surgery.
REFERENCES: 1. Acta Anaesthesiol Scand 1982; 26: 48-53 2. Anesthesia 1984; 39: 1172-6
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