Efficacy of Ephedrine in the Prevention of Postoperative Nausea and Vomiting

Abstract

Although reported in the aerospace literature and anecdotally by anesthesiologists, the putative antiemetic effect of ephedrine remains unquantitated. We therefore prospectively studied ephedrine as an antiemetic agent in the perioperative setting in 97 patients undergoing general anesthesia for outpatient gynecologic laparoscopy. Patients were assigned in a double-blind randomized fashion to receive a standardized general anesthetic followed by an intramuscular dose of either ephedrine (0.5 mg/kg), droperidol (0.04 mg/kg), or saline before the conclusion of surgery. Nausea, retching, or vomiting, as well as the degree of sedation and discharge times, were assessed in the recovery room and for 24 h postoperatively. Ephedrine was found to have a significantly antiemetic effect (P less than 0.05) when compared with placebo and an antiemetic effect similar to that of droperidol. Sedation scores were also significantly less in the ephedrine group than in both placebo and droperidol groups. Finally, variations in mean arterial blood pressure among the three groups were not statistically significant. We conclude that ephedrine is an effective antiemetic agent with minimal sedative side effects in patients undergoing outpatient laparoscopy.

Intramuscular ephedrine reduces emesis during the first three hours after abdominal hysterectomy

“…Thus, it seems that both ephedrine and metoclopramide have a limited duration of action in the doses we used. This is in accordance with the study of Rothenberg et al ( 8), where they found a significant antiemetic effect of ephedrine during the recovery room phase of 76–96 min, whereas no protective effect was evident during the next 24 h. Also, metoclopramide has previously been shown to have a shortlasting antiemetic effect ( 9, 10). Whereas ondansetron has been shown to be effective as PONV prophylaxis for 24 h ( 11), all our patients rescued with ondansetron during the first 3 h experienced PONV during the subsequent 3–24 h period.…”

“…The benefits of a multimodal approach may also explain why only 8% of the ephedrine patients needed both metoclopramide and ondansetron for rescue, whereas 32% of the placebo patients needed this double rescue. Whereas metoclopramide is mostly a dopamine antagonist and ondansetron is a 5‐HT 3 antagonist ( 1), ephedrine has a sympatomimetic action which has been shown to be antiemetic ( 14), probably by counteracting emetic vagal stimuli ( 8).…”

“…It has been speculated whether the antiemetic action of ephedrine is purely an effect of minimizing hypotension postoperatively ( 8). In our study, however, we were not able to demonstrate any difference in postoperative blood pressure between the two groups, either during the routine measurements or the frequent measurements taken during episodes of PONV.…”

“…Thus, there is still a lot of interest in the cheap, “old” antiemetic drugs, such as metoclopramide and droperidol ( 7). In a study by Rothenberg et al, ephedrine was demonstrated to have an antiemetic effect for 90 min after gynaecologic laparoscopy ( 8). There are, however, no recent peer‐reviewed studies about the efficacy of ephedrine in the prophylaxis of PONV.…”

The effect of perioperative esmolol infusion on the postoperative nausea, vomiting and pain after laparoscopic appendectomy

“…Another mechanism involved in the prevention of esmolol-related PONV could be the excessive perioperative cardiovascular changes [13]. So the use of esmolol can mitigate such perioperative hemodynamic changes and prevent PONV [14,15].…”