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

Schnabel, Alexander; Eberhart, Leopold; Muellenbach, Ralf Michael; Morin, A. M.; Roewer, Norbert; Kranke, Peter

doi:10.1097/eja.0b013e32833b7969

Cited by 30 publications

(10 citation statements)

References 36 publications

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“…As such, these drugs are no longer recommended as first-line antiemetic agents [16]. Use of phenothiazines as an antiemetic has been shown to be efficacious in postsurgical patients when combined with other antiemetics and in pediatric patients for PONV and post-discharge nausea and vomiting (PDNV) [17,18]. Phenothiazines have shown only moderate efficacy and significant side effects when used to treat pediatric CINV [19,20].…”

Section: Phenothiazinesmentioning

confidence: 98%

Safety and efficacy of commonly used antiemetics

Hendren

Aponte-Feliciano

Kovac³

2015

Expert Opinion on Drug Metabolism & Toxicology

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The key to providing relief for patients suffering from nausea and vomiting is to consider multiple drugs to approach the nausea in a systematic way. Anesthesiologists identify patients who are at high risk of nausea and vomiting based on physical characteristics and surgical procedures. Oncologists treat nausea based on the prescribed chemotherapeutics regimen and known risk of emesis while palliative care physicians and others balance the etiology of the nausea while optimizing patients other co morbid conditions.

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Section: Phenothiazinesmentioning

confidence: 98%

Safety and efficacy of commonly used antiemetics

Hendren

Aponte-Feliciano

Kovac³

2015

Expert Opinion on Drug Metabolism & Toxicology

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“…in adults, published between 1965 and 1999. 6 Perphenazine was shown to be effective for early PONV in all four studies, reducing risk of PONV to close to 30%, which is similar to that of dexamethasone 4 mg, ondansetron 4 mg, or droperidol 1.25 mg. 7 Despite our understanding of the effectiveness of perphenazine, limited information exists on the side effects of low dose, short-term use or single-dose use. Year on year, perphenazine administration at our institution has increased significantly (Figure 1).…”

Section: Discussionmentioning

confidence: 71%

Extrapyramidal symptoms following administration of oral perphenazine 4 or 8 mg

Henao¹,

Peperzak²,

Lichvar³

et al. 2014

European Journal of Anaesthesiology

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Background Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown. Objective A retrospective analysis of patient medication billing data and departmental quality records was performed (January 2001 – 10 July 2012) to identify patients who experienced EPS dysfunction after oral perphenazine. Design Retrospective analysis. Setting Surgical outpatients presenting to any one of ten hospitals in the area of Pittsburgh, PA, USA. Patients, other participants Overall, 45,766 patients received 4 or 8 mg of perphenazine before same-day surgery. Main Outcome Measures EPS dysfunction was defined as acute dystonia, akathisia, or pseudoparkinsonism. Records were reviewed to determine the (i) likely number of reactions to perphenazine, (ii) nature of these reactions, and (iii) impact on patient care. Results There were four “likely” cases of EPS dysfunction, and two “possible” cases. Five reported events were consistent with akathisia, with the sixth being a dystonic reaction. All six patients had resolution of symptoms, with five receiving intravenous diphenhydramine for treatment. The incidence of EPS dysfunction was 1.3 events per 10,000 patients (95% CI: 0.4, 3.0, based on 6 events). All patients who experienced reactions preoperatively were able to proceed to surgery without complications or delay. One patient required unplanned admission and 3-hour observation due to sedation from diphenhydramine. The incidence of EPS dysfunction after oral perphenazine is low. Reactions that did occur were mild and easily treated. Conclusions Given the infrequent side-effects, this single, low-dose of perphenazine should be encouraged as a low-risk adjunct to any multimodal PONV prophylaxis regimen, based on the selection criteria described.

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“…A review of 6 RCTs showed a relative risk reduction (RRR) of 0.5 (95 % CI, 0.37-0.67) for PONV when using 5 mg IV perphenazine [ 65 ]. This same review showed no significant increase in sedation or drowsiness when compared with a placebo [ 65 ]. Metoclopramide is not effective at 10 mg dose.…”

Section: Phenothiazinesmentioning

confidence: 77%

Prevention of Postoperative Nausea and Vomiting

Owen

Gan

2015

The SAGES / ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery

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Postoperative nausea and vomiting (PONV) are common and unpleasant complications of anesthesia and surgery. The overall incidence rate of PONV for all surgical patients is estimated to be 25-30 %, while the rate of PONV in high-risk patients can be as high as 80 % [ 1 -4 ]. An estimated 0.18 % of patients experience intractable PONV, which may result in prolonged postanesthesia care unit (PACU) stay, unanticipated hospital readmission, and increased health care costs [ 5 -7 ]. PONV represents one of the most common reasons for poor patient satisfaction scores in the postoperative period [ 8 ]. One survey found that patients would be willing to pay up to $100, at their own expense, for complete and effective antiemetic treatment [ 9 ].The aim of this chapter will be to summarize the evidence for the implementation of PONV protocols within an enhanced recovery after surgery program (ERP). Literature used for these recommendations come from randomized control trials, meta-analyses, and consensus guidelines. We will address the following: identifying high-risk patients, minimizing risks, administering appropriate prophylactic antiemetic and rescue treatment, and recommending a treatment algorithm for use in an ERP protocol. Identifying High-Risk PatientsThere are several factors that have been associated with increased risk of PONV, but to effectively stratify risk, one should focus on those factors that independently predict PONV. These factors include female sex, history of PONV or motion sickness, nonsmoking status, younger 80 age, general versus regional anesthesia, use of volatile anesthetics and nitrous oxide, postoperative opioids, duration of surgery, and type of surgery (cholecystectomy, laparoscopic, gynecological) [ 10 ]. The increased incidence of PONV with laparoscopic surgeries and cholecystectomies is particularly relevant when considering ERP protocols for gastrointestinal surgery [ 11 ]. To ease the task in risk stratification, Apfel et al.[ 1 ] developed a simplified risk score, based on four predictors: female gender, history of motion sickness or PONV, nonsmoking status, and the use of opioids for postoperative analgesia. The incidence of PONV in patients with 0, 1, 2, 3, or 4 of these risk factors was 10, 21, 39, 61, and 79 % respectively (Fig. 8.1 ) [ 1 ]. The use of this simplified risk score to guide therapeutic interventions has been shown to dramatically reduce institutional rates of PONV [ 12 -14 ] (Fig. 8.2 ). Reducing Baseline RisksThere are several strategies that can be used to reduce the baseline risk of PONV: Avoiding general anesthesia by the use of regional anesthesia; Using propofol, an antiemetic in its own right, for induction and maintenance of anesthesia; Avoiding nitrous oxide; Avoiding volatile anesthetics; Minimizing intraoperative and postoperative opioids; and adequate hydration [ 10 ]. The complete avoidance of general anesthesia is not generally practical for gastrointestinal surgery; however, the use of transversus abdominis plane (TAP) blocks as part of the analgesi...

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

Abstract: there is evidence that perphenazine is effective in the prevention of PONV in children and adults without serious adverse effects compared with placebo.

Cited by 30 publications

References 36 publications

Safety and efficacy of commonly used antiemetics

Safety and efficacy of commonly used antiemetics

Extrapyramidal symptoms following administration of oral perphenazine 4 or 8 mg

Prevention of Postoperative Nausea and Vomiting

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