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

Abstract

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.

Meta-Analysis of the Safety of 5-HT3 Antagonists with Dexamethasone or Droperidol for Prevention of PONV

“…Nine RCTs provided safety data comparing 5-HT 3RA combination therapy with comparator monotherapy treatmentarms; 5 compared5-HT 3RA1droperidol with droperidol monotherapy,21,24,29.10,44 and 4 compared 5-HT 3RA1dexamethasone with dexamethasone monotherapy. 21,24,29,30,44 Median incidence rates for 5-HT 3RA/steroid treatment groups were headaches 8% (n = 8 studies), dizziness 4% (6), drowsiness 3% (6), dizziness0% (5), and any adverse event 9% (6). Infrequently reported adverseevents included pulmonary (oxygensaturation [Sa02] <94%),42 cardiac abnormalltiesj!…”

“…There were no reports of pulmonary complications, extrapyramidal symptoms, avascular necrosis, occult infection, or delayed wound healing among studies using combinations of 5-HT JRAs with droperidol for prophylaxis of PONVJ1, 24,27,29,30,44 Although one study by Eberhart et al," reported cardiac abnormalities, the incidence of arrhythmias in patients treated with dolasetron/droperidol was nearly identical to that observed in patients administered placebo (3.9% vs 3.8%), as was that for bradycardia (23.7% vs 25.6%) and cardiovascular adverse effects, including hypertension or hypotension requiring treatment (9.2% vs 9.0%).…”

Management of Postoperative Nausea and Vomiting in Women Undergoing Major Gynecological Surgery: A Review and Update

“…immdeiately before induction of anesthesia, was more effective than granisetron or droperidol for preventing PONV [47]. By contrast, Peixoto et al found no difference in the efficacy between patients receiving droperidol 1.25 mg and ondansetron 4 mg and those receiving each drug alone [48].…”

“…Therefore, it is possible that a combination of antiemetics with different sites of activity would be more effective than one drug alone. Combination antiemetic therapy is effective for preventing PONV in women undergoing major gynecological surgery [46][47][48][49][50][51] (Table 4). Three investigations evaluated the efficacy of serotonin receptor antagonists (ondansetron, granisetron) with droperidol in the prevention of PONV [46][47][48][49][50].…”

Impact of perioperative care on the post-operative recovery of women undergoing surgery for gynaecological tumours

“…; Peixoto et al . ). There are several factors causing PONV, generally related to the particular surgical procedure or patient‐specific risk factors.…”