Reduction of post-operative nausea and vomiting with the combination of morphine and dropéridol in patient-controlled analgesia

Klahsen, Andrew; O’Reilly, Deirdre; McBride, John; Ballantyne, Margaret; Parlow, Joel L.

doi:10.1007/bf03011835

Cited by 32 publications

(26 citation statements)

References 26 publications

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“…One criticism that might be leveled at the study design is that droperidol-induced sedation may have influenced evaluation of analgesic effect in the postoperative period. However, based on previous articles that have shown similar sedation scores for groups treated with and without droperidol, this suggestion seems unlikely [5,6,17]. In our study, between-group sedation scores were comparable at 6 and 12 hours postoperatively, and all patients were at normal alertness 24 to 72 hours postoperatively.…”

Section: Discussioncontrasting

confidence: 63%

Morphine sparing with droperidol in patient-controlled analgesia

Chia

Liu

et al. 2005

Journal of Clinical Anesthesia

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Section: Discussioncontrasting

confidence: 63%

Morphine sparing with droperidol in patient-controlled analgesia

Chia

Liu

et al. 2005

Journal of Clinical Anesthesia

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“…These have included administering nonsteroidal anti-inflammatory drugs plus morphine, ß-2 adrenergic agonists plus morphine, and low concentrations of local anesthetics plus morphine. 6 Klahsen et al 7 and Isosu et al 8 found that epidural droperidol could reduce morphine-induced nausea and vomiting. However, continuous epidural administration of droperidol may trigger such side effects as dystonia and akathisia.…”

Section: Discussionmentioning

confidence: 98%

Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine

Choi¹,

Lee²,

Choi³

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine whether epidural naloxone preserved analgesia while minimizing side effects caused by epidural morphine.Methods: Eighty patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of four groups. All received 2 mg epidural morphine bolus one hour before the end of surgery and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n=20), 0.083 µg·kg of naloxone (Group 4, n=20). Analgesia and side effects were evaluated by blinded observers.Results: The combination of epidural morphine and bupivacaine provided good analgesia. Eight hours after the end of surgery, the pain score in the group receiving the highest dose of naloxone was lower than in the control group (VAS 1.2 vs 2.0, P < 0.05) but there was less pruritus in the high-dose naloxone group (itching score 1.3 vs 1.9, P < 0.05). Pain scores were no different in any of the naloxone groups from the control group. Itching was less in both of the higher dose naloxone groups (P < 0.05 at 8, 16, and 32 hours). The incidence of vomiting in the control group was 40% vs 5% for high dose naloxone group (P < 0.05).Conclusions: Epidural naloxone reduced morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect. Objectif Objectif :: Déterminer si la naloxone épidurale préserve l'analgésie tout en réduisant les effets secondaires de la morphine épidurale. Méthode Méthode :: Quatre-vingt patientes devant subir une hystérectomie avec une anesthésie péridurale et générale combinée ont été réparties au hasard en quatre groupes. Toutes ont reçu un bolus de 2 mg de morphine épidu-rale une heure avant la fin de l'opération et une perfusion épidurale continue a été amorcée avec 4 mg de morphine dans 100 ml de bupivacaïne 0,125 % sans naloxone (Groupe 1, n = 20), avec 0,083µg·kg -1 ·h -1 de naloxone (Groupe 2, n = 20), ou 0,125µg·kg : La combinaison de morphine épidurale et de bupivacaïne a fourni une bonne analgésie. Huit heures après la fin de l'intervention chirurgicale, le score de douleur chez les patientes qui ont reçu la plus forte dose de naloxone était plus bas que celui des patientes du groupe témoin (EVA 1,2 vs 2,0, P < 0,05), et il y avait moins de prurit chez les patientes ayant reçu la dose élevée de naloxone (score de 1,3 vs 1,9, P< 0,05). Les scores de douleur n'ont pas montré de différence intergroupe. Le prurit était moins marqué chez les patientes des deux groupes qui ont reçu les doses plus élevées de naloxone ( P < 0,05 à 8, 16, et 32 heures). L'incidence des vomissements chez les patientes témoins a été de 40 % vs 5 % pour les femmes ayant reçu une forte dose de naloxone P < 0,05).Conclusion : L'administration épidurale de naloxone réduit les effets secondaires induits par la morphine d'une façon qui dépend de la dose sans renverser l'effet de l'analgésique.

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“…Ludwin and Shafer, however, suggested that the FDA was justified in placing a warning on a drug that was linked to potentially harmful adverse effects, although the label should be clarified. 15 Although some clinical trials have proven the efficacy and safety of low-dose droperidol for management of PONV, 5,9,16,17 the clinical settings vary from study to study, and it is questionable whether the results from controlled trials can be satisfactorily generalized to routine clinical practice in different settings. After reviewing the literature above, we initiated a month-long clinical investigation in August 2008 to evaluate the ramifications of discontinuing droperidol in the IVPCA regimen as a pilot study to confirm whether droperidol is a necessary adjuvant for IVPCA.…”

Section: Introductionmentioning

confidence: 98%

“…3,4 The management of postoperative pain with intravenous patient-controlled analgesia (IVPCA) is common in many hospitals due to its rapid and reliable analgesic effect, avoidance of intramuscular injections, and high patient satisfaction. 5 However, opioid-based IVPCA is highly emetogenic, and it has been reported that as many as two-thirds of patients may suffer an emetic event without treatment during their IVPCA course. 6 Previous studies have demonstrated that the combination of droperidol and morphine in IVPCA infusate reduces PONV to a greater extent than a single perioperative dose does.…”

Section: Introductionmentioning

confidence: 99%

To add or not to add? An empirical study on droperidol and intravenous patient-controlled analgesia

Kuo¹,

Tsou²,

Chang³

et al. 2012

Journal of the Chinese Medical Association

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Reduction of post-operative nausea and vomiting with the combination of morphine and dropéridol in patient-controlled analgesia

Abstract: Purpose: To determine whether low doses of droperidol mixedwith morphine in patient-controlled analgesia (PCA) 1, 2, 4, 8, 12, 16, 20 et 24 de l'intervention (P < 0,03). Les scores moyens de s~dation dtaient bas dans tousles groupes mais augmentaient avec le dropdridol en PCA (P < 0,02).

Cited by 32 publications

References 26 publications

Morphine sparing with droperidol in patient-controlled analgesia

Morphine sparing with droperidol in patient-controlled analgesia

Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine

To add or not to add? An empirical study on droperidol and intravenous patient-controlled analgesia

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