Combination of Ondansetron and Droperidol in the Prophylaxis of Postoperative Nausea and Vomiting

Abstract

The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. Patients were randomly assigned to receive placebo (Group 1, n = 25), droperidol 2.5 mg with induction of anesthesia and 1.25 mg 12 h later (Group 2, n = 25), ondansetron 4 mg with induction (Group 3, n = 25), and ondansetron plus droperidol at the same doses as Groups 3 and 2, respectively (Group 4, n = 25). A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.

Postoperative nausea and vomiting after breast surgery: efficacy of prophylactic ondansetron and droperidol in a randomized placebo-controlled study

“…Ondansetron and droperidol may thus be less effective prophylactic agents in breast surgery than in gynaecological and abdominal surgery. However, the incidence of PONV still remained high in some of the studies referred to, varying between 37% and 72% after ondansetron 4-8 mg and 24% and 83% after droperidol 1.25-2.5 mg were administered; these figures are in accordance with our results [13][14][15]18].…”

“…Prospective studies of a combination of antiemetic drugs, such as ondansetron and droperidol, appear to be of interest, because various antiemetic drugs have different receptors and sites of action; improved results can therefore be expected [15]. Another method of reducing PONV in breast surgery may be the use of propofol to induce and maintain anaesthesia [9].…”

“…However, 5-HT 3 receptor antagonists are much more expensive than other antiemetics. Some recent studies have reported no better efficacy of ondansetron than of droperidol in reducing PONV in patients undergoing gynaecological surgery [13][14][15]. So far there have been few studies on antiemetic prophylaxis for patients undergoing breast surgery [9,16].…”

Dixyrazine for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

“…Intravenous droperidol administered at the end of anesthesia has been shown to compare favorably with the newer but more expensive 5-HT3 receptor antagonists (2). Several studies have also indicated, however, that combination regimens will prevent postoperative nausea and vomiting more effectively than either droperidol or 5-HT3 receptor antagonists as monotherapy (12). This synergism is attributed to activation of additional emesis-related receptors.…”

Impact of Antiemetic Selection on Postoperative Nausea and Vomiting and Patient Satisfaction

“…Data did not show better outcomes with multiple-drug regimens, in contrast to previous studies in the literature. [36][37][38][39][40][41] A recent meta-analysis of 17 randomized, controlled trials involving 1946 ambulatory and inpatient surgery patients was performed to define the antiemetic efficacy and safety of dexamethasone in prevention of PONV. 36 Prophylactic dexamethasone was effective in reducing PONV without clinically relevant toxicity in otherwise healthy patients.…”