Perphenazine decreases vomiting by children after tonsillectomy

Abstract

Purpose: To test the hypothesis that perphenazine decreases the incidence of vomiting by children after tonsillectomy. Methods: Healthy children (n = 260) aged 2-12 yr undergoing elective tonsillectomy on a day care surgical basis were studied in this randomised, stra~ed, blocked, double-blind investigation. General Anaesthesia was induced intravenously with propofol or by inhalation with halothane and N20. Perphenazine 70/Jg.kg -I up to 5 mg or placebo/v was administered before surgery, Management of perioperative fluids, emesis and pain were all standardised. ~ults: The groups were similar with respect to demographic data. There was less vomiting after perphenazine during the first 24 hr after surgery 4296 (95% CI = 34o/0-5096) vs 57% (9596 CI = 4896-6696, placebo), P < 0.01. On the day of surgery, both in and out-of hospital emesis were decreased by perphenazine. The perphenazine treated patients required fewer rescue antiemetics than the control group, P < 0.05. Each episode of in-hospital vomiting delayed discharge by 20 _+ 7 rain (mean _+ SD), P = 0.007. Conclusion= The prophylactic administration of perphenazine decreases vom~ng by children alter tonsillectomy.Objectif : V6rifier si la perph6nazine diminue l'incidence des vomissements apr~s une amygclalectomie chez l'enfant.M6thodes : Des enfants bien portants (n = 260) ~g~s de deux ~ 12 arts soumis ~ une amygdalectomie en chirurgie rEgl6e dans un centre de jour ont partidpE ~ cette investigation randomis6e, stratifl6e, avec blocs et en double aveugle. I'anesthEsie g6n&ale 6talt induite par la vole veineuse de propofol ou par inhalation d'halothane et de N20. Avant la chirurgie, on administrait iv de la perph6nazine 70/jg.kg -~ jusqu'~ 5 mg ou un placebo. La prise en charge des liquides l:~riop6ratoim~s, des vomissements et de la douleur ~tait uniformis6e.R~sultats : Les groupes 6talent comparables sous l'aspect d6mographique. Les vomissements survenaient moins souvent apr#.s la perphEnazine pendant les premieres 24 h postchiru~cales, 42% (IC 95% = 3496-50%) vs 5796 (IC 9596 = 48%-66%), P < 0.0 I. Le jour de la chirurgie, les (~pisodes 6m6tiques intra-et extrahospitaliers diminualent sous perph6nazine. Les patients trait& i~ la perph6nazine ont eu besoin de moins d'anti6m6-tiques de sauvetage que le groupe contr61e, P < 0,05. Chaclue 6pisode de vomissements intrahospitaliers a retard6 le cong~ de I0 _+ 7 min (moyenne +_ L~I'), P = 0,007.

Efficacy of perphenazine to prevent postoperative nausea and vomiting: a quantitative systematic review

“…No trials in adults reporting this outcome were included in this systematic review. Only one study 24 in 162 adults and one study 29 in 258 children reported data over the total postoperative period. In adults, 0.11 mg kg À1 of perphenazine was Table 1 Excluded studies and reasons for exclusion…”

“…Because of lack of appropriate data, thesepre-hoc planned subgroup analyseswere not possible. For the late postoperative period, there was only one study 29 in 258 children available. The RR for the administration of 0.07 mg of perphenazine after induction versus placebo was 0.66 (95% CI 0.44-0.97).…”

“…26 or intravenous(ly) (i.v.). 22,25,27 -30 The application time was either at the time of the sedating premedication on the ward, 21,22,26 close to the induction of anaesthesia 25,[27][28][29][30] or concomitant with the extubation. 23,24,31 Efficacy of perphenazine was tested in adults having a cholecystectomy or gynaecological surgery and in children undergoing tonsillectomy.…”

“…All studies with one 29 exception evaluated the efficacy of perphenazine Perphenazine to prevent postoperative nausea and vomiting 1045 versus at least one active control, but only two drugs, namely granisetron 26,27 and metoclopramide, 22,23,25,31 were tested twice or more as the control intervention. Four trials [21][22][23][24] in adults tested the efficacy of perphenazine versus placebo as a subgroup, whereas one study 29 in children exclusively investigated the antiemetic efficacy versus an inactive control.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20] Eleven randomised, controlled trials (six trials in adults and five trials in children), published between 1965 and 1999, were finally included in the review (Tables 2 and 3). 18,[21][22][23][24][25][26][27][28][29][30] The data of 2081 participants (805 patients received perphenazine and 1276 received another drug or placebo as control) could be analysed. Sex distributionif available from the published trials -showed a larger proportion of women being studied (1368 women and 239 men were investigated).…”