Is Low-Dose Haloperidol Effective against Postoperative Nausea and Vomiting? A Randomized Controlled Trial

Abstract

<b><i>Background:</i></b> Nausea and vomiting are undesirable outcomes during the postoperative period. Vomiting may cause life-threatening pulmonary aspiration, as the airway reflex may not be fully restored postoperatively due to the residual effects of anesthetic and analgesic medications. <b><i>Objective:</i></b> The aim of this study is to determine the effective dosage of haloperidol against nausea and vomiting, as well as its adverse effects. <b><i>Materials and Methods:</i></b> A total of 250 female patients between the ages of 19 and 70, who were admitted for laparoscopic abdominal hysterectomy, were included in this study. The patients were randomized into five groups: placebo (<i>n</i> = 50) (Group I), haloperidol 2 mg (<i>n</i> = 50) (Group II), haloperidol 1 mg (<i>n</i> = 50) (Group III), haloperidol 0.5 mg (<i>n</i> = 50) (Group IV), and haloperidol 0.25 mg (<i>n</i> = 50) (Group V). The patients’ duration of anesthesia, duration of surgery, and nausea/vomiting scores were recorded, along with the antiemetic agents used. The Aldrete’s recovery scale was used as the postoperative recovery criteria. Data from the following variables were recorded for all patients at postoperative minute 30 and hours 1, 2, 3, 4, 6, 12, and 24: heart rate, systolic arterial pressure, diastolic arterial pressure, level of sedation, visual analog scale values, antiemetic need, patient satisfaction, side effects. <b><i>Results:</i></b> It was determined that 0.5, 1, and 2 mg doses of haloperidol were effective in preventing nausea and vomiting, and there was no difference in effectiveness between the 0.25 mg dose group and placebo. <b><i>Conclusion:</i></b> Haloperidol was found to be an effective agent against nausea and vomiting at a dose of 0.5 mg and can be administered at the doses of 0.5 mg to 2 mg.

Comparison of Nausea and Vomiting Incidence After Laparoscopic Cholecystectomy With Pretreatment With Haloperidol and Ondansetron: A Randomization Clinical Trial Study

“…In another study that compared the effect of different doses of haloperidol against normal saline, the findings showed that haloperidol was effective compared with normal saline for PONV. 18 The Consensus guidelines for managing PONV published in 2003 did not endorse the safety and efficacy of the S-HT3 antagonist and dexamethasone to control PONV in high-risk patients, even did not endorse dexamethasone as an adjunctive therapy; while the effect of haloperidol at low doses has been confirmed. 20…”

“…Also, the study conducted by Pazoki et al 32 found that the PONV incidence was significantly higher in the normal saline group than in the other 2 groups(4 mg and 8 mg ondansetron) at 24 hours. In another study that compared the effect of different doses of haloperidol against normal saline, the findings showed that haloperidol was effective compared with normal saline for PONV 18 …”

“…17 Haloperidol is widely used in psychiatric disorders, although it is also used in PONV due to its antiemetic effects. 18 The antinausea effect of haloperidol is due to its central effect on dopamine D2 receptors. 19 Alpha-adrenergic and muscarinic receptors are also partially blocked by haloperidol.…”

“…Haloperidol is a well-known and old drug in the butyrophenones category 17 . Haloperidol is widely used in psychiatric disorders, although it is also used in PONV due to its antiemetic effects 18 . The antinausea effect of haloperidol is due to its central effect on dopamine D2 receptors 19 .…”