Continuous epidural, not intravenous, droperidol inhibits pruritus, nausea, and vomiting during epidural morphine analgesia

Antipruritic and antiemetic effect of epidural droperidol

“…This prolonged effect of droperidol in our study might be explained by a receptor-mediated central mechanism which inhibits opioid-induced pruritus [13,14]. A 'scratching centre,' which lies in the medulla oblongata in animals, may have an anatomical correlation in human beings [15].…”

“…prolonged duration of central spinal action of epidural droperidol might suggest the epidural route as a good choice of administration. Nakata and colleagues [13] reported that intraoperative single i.v. injection of droperidol (2.5 mg) did not decrease the frequency or severity of pruritus.…”

Epidural haloperidol enhances epidural morphine analgesia: Three case reports

“…Studies of epidural droperidol on postoperative analgesia have shown mixed results, with recent clinical trials among patients completing thoracic or abdominal surgery failing to demonstrate any analgesic effect. 27,28 Differences in opioid administered, administration method, or surgical site have all been postulated to contribute to the varied outcomes of epidural droperidol on postoperative analgesia. 8 The possible risks of epidural haloperidol administration are unknown.…”

Complications Associated with Continuous Epidural Analgesia

“…A meta-analysis of randomized trials examining continuous epidural analgesia indicated that continuous epidural analgesia solutions consisting of a local anestheticbased regimen (with or without opioid) appeared to generally have a lower incidence of PONV compared with an opioid-only regimen (i.e., up to 42% PONV with a local anesthetic-based solution versus up to 60% PONV with opioids alone) [1]. In addition, the cumulative incidence of PONV may be higher in those receiving continuous infusions of opioids rather than a single-shot dose (45 to 80% versus 20 to 50%) [22,23,25,26]. In addition, the cumulative incidence of PONV may be higher in those receiving continuous infusions of opioids rather than a single-shot dose (45 to 80% versus 20 to 50%) [22,23,25,26].…”

“…• lnfusions of opioid-alone > combined opioid + local anesthetic infusions • Morphine > fentanyl • Continuous infusion > single-shot epidural injections (cumulative incidence) dexamethasone, and transdermal scopolamine) may be used to treat PONV, the majority of trials have examined these agents for the prevention and treatment of PONV associated with primarily single-shot neuraxial opioids, not continuous epidural infusions of opioids [25,26,32,33] (Box 18-2).…”