Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting

Abstract

Purpose: To estimate the efficacy and harm produced by droperidol in the prevention of postoperative nausea and vomiting (PONV). Methods: Systematic search (MEDLINE, EMBASE, Cochrane library, hand-searching, bibliographies, all languages, up to May 1999) for randomised comparisons of droperidol with placebo in surgical patients. Relevant end points were prevention of early PONV (up to six hours postoperatively), and late PONV (24 hr), and adverse effects. Combined data were analysed using relative risk and NNT. Results: In 76 trials, 5,351 patients received 24 different regimens of droperidol. The average incidence of early and late PONV in controls was 34% and 51%, respectively. Droperidol was more efficacious than placebo in preventing PONV. In adults, the anti-nausea effect was short-lived, and there was no dose-responsiveness; with 0.25 to 0.30 mg the number-needed-to-treat (NNT) to prevent early nausea was 5. For both early and late anti-vomiting efficacy there was dose-responsiveness; best efficacy was with 1.5 mg to 2.5 mg (NNT, 7). In children, there was dose-responsiveness; best efficacy was with 75 µg·kg -1 (NNT to prevent early and late vomiting, 4). Two children had extrapyramidal symptoms with droperidol (NNT in children, 91; in any patient, 408). There was dose-responsiveness for sedation and drowsiness (with 2.5 mg the NNT was 7.8). Droperidol prevented postoperative headache (NNT,. Conclusions: Droperidol is anti-emetic in the surgical setting. The effect on nausea is short-lived but more pronounced than the effect on vomiting. Sedation and drowsiness are dose-dependent, extrapyramidal symptoms are rare, and there is a protective effect against headache.Objectif : Évaluer l'efficacité et les effets négatifs du dropéridol utilisé pour la prévention de nausées et de vomissements postopératoires (NVPO). Méthode : Recherche documentaire systématique (MEDLINE, EMBASE, bibliothèque Cochrane, recherche manuelle, bibliographies, dans toutes les langues jusqu'à mai 1999) pour établir des comparaisons randomisées de dropéridol avec un placebo chez des patients de chirurgie. Les paramètres étudiés ont été la prévention des NVPO précoces (jusqu'à six heures après l'opération) et tardifs (24 h) et les effets indésirables. Les données combinées ont été analysées en utilisant le risque relatif et le nombre nécessaire au traitement (NNT). Résultats : Résultats : Pour 76 essais, 5 351 patients ont reçu 24 régimes différents de dropéridol. L'incidence moyenne de NVPO précoces et tardifs chez les témoins a été de 34 % et 51 %, respectivement. Le dropéridol a été plus efficace que le placebo pour prévenir les NVPO. Chez les adultes, l'effet anti-nausée a été de courte durée et il n'y a pas eu de réponse en fonction de la dose; avec 0,25 à 0,30 mg, le NNT pour prévenir les nausées précoces a été de 5. Pour prévenir efficacement les vomissements précoces et tardifs, il y avait une réponse dépendante de la dose; la plus efficace a été de 1,5 mg à 2,5 mg (NNT, 7). Chez les enfants, pas de réponse selon la dose; l'effica...

Evidence-based management of postoperative nausea and vomiting: a review

“…For both early and late vomiting, the best efficacy was with 1.5 to 2.5 mg (NNT = 7). 31 In children, the recommended dose is 50 to 75 µg·kg -1 with a NNT of 4 (IIA). 31 It has a long duration of action (as long as 24 hr following administration) probably due to its strong binding affinity to the emetic receptors; even though its half-life is relatively short (three hours).…”

“…31 In children, the recommended dose is 50 to 75 µg·kg -1 with a NNT of 4 (IIA). 31 It has a long duration of action (as long as 24 hr following administration) probably due to its strong binding affinity to the emetic receptors; even though its half-life is relatively short (three hours). 60 Droperidol is most effective when given at the end of surgery (IIA).…”

“…The available options for PONV prophylaxis are presented in Table III. A number of antiemetic interventions have been studied in systematic reviews. 9,14,[29][30][31][32][33][34][35][36][37][38] As a measure of antiemetic efficacy, the number needed-to-treat (NNT) is calculated. In this context, the NNT indicates the number of patients needed to receive a particular antiemetic intervention to prevent one emetic event that would have occurred had the patient not received the intervention.…”

The timing of haloperidol administration does not affect its prophylactic antiemetic efficacy

“…A systemic review suggested that droperidol's antiemetic efficacy, when given at the end of surgery, may have been exaggerated. 2 Since haloperidol is pharmacologically similar to droperidol for the control of nausea and vomiting, and since the time to peak plasma concentration from intravenous injection is only five to 15 min, 17 the drug might be more effective when administered at the end of surgery, thereby producing a more sustained antiemetic effect in the postoperative period. However, our results show that haloperidol 2 mg iv administered during induction of anesthesia, achieves similar antiemetic efficacy as compared to the same drug dose given 30 min prior to completion of surgery.…”

“…1 Droperidol, a butyrophenone, has frequently been used for preventing PONV after general anesthesia. 2 However, recent warnings regarding the safety of droperidol have limited its routine use. 3 Haloperidol is also a butyrophenone with antiemetic properties, but without the U.S. Food and Drug Administration (FDA) restrictions.…”