PURPOSE: To examine the impact of adding droperidol to fentanyl-based intravenous patient-controlled analgesia (IVPCA) on the discontinuation of IVPCA use due to postoperative nausea and vomiting (PONV). METHODS: Patients who underwent surgeries other than abdominal surgeries and used IVPCA between April 2014 and March 2018 were selected. Patients using IVPCA with fentanyl alone were compared to patients using droperidol added to IVPCA. Patients were allocated to one of two groups depending on the drug used for IVPCA: 1) control group, fentanyl alone; 2) droperidol group, droperidol with fentanyl. The primary endpoint was the discontinuation of IVPCA due to PONV. Secondary endpoints included PONV within 48 hours after surgery, the number of antiemetics used, pain score, and adverse effects. Propensity score matching was used to control the differences in clinical features among patients. RESULTS: Among the 793 patients initially enrolled in this study, 145 were excluded via propensity score matching; 364 of the remaining patients received IVPCA supplemented with droperidol. Propensity score matching showed that discontinuation of IVPCA due to PONV was significantly decreased in the droperidol group compared to the control group (P = 0.01). Further, compared with the control group, the droperidol group had reduced nausea up to 24 hours after surgery (P < 0.01), and the number of vomiting episodes and use of antiemetics decreased within 12 hours after surgery (P < 0.01). CONCLUSIONS: The addition of droperidol to IVPCA is associated with a decrease in PONV, as well as the improved continuation of pain treatment with fentanyl-based IVPCA, similar to IVPCA with morphine. However, it is necessary to monitor the side effects of this treatment.
One of the causes of preoperative hypokalemia is the prolonged use of herbal medicines, especially licorice. Licorice can induce pseudo-aldosteronism, hypertension, metabolic alkalosis, and hypokalemia. An 87-year-old woman with a history of knee osteoarthritis was scheduled to undergo a total knee arthroplasty (TKA) under spinal anesthesia. She had also been prescribed herbal medicine for osteoarthritis of the knee two years before the surgery. During the surgery, the pulse oximeter showed hypoxemia. After the surgery was completed, arterial blood sampling showed hypoxemia, hypokalemia with electrocardiography (ECG) abnormalities, and metabolic alkalosis. The symptoms improved after the discontinuation of herbal medicines and administering potassium chloride. It is necessary to suspect electrolyte abnormalities as one of the causes of hypoxemia, hypertension, or ECG abnormalities in patients prescribed herbal medicines. Therefore, it is also important to ensure that patients on such drugs have their blood potassium levels assessed frequently in the perioperative period.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.