The antiemetic effectiveness of droperidol during morphine patient‐controlled analgesia

Abstract

SummaryThis prospective, double-blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient-controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter 'Infusor' patient-controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to thejirst use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during thejirst 12 h after operation. Key wordsPain; postoperative. Vomiting; antiemetics, droperidol.Patient-controlled analgesia (PCA) is an effective and increasingly popular method of providing postoperative analgesia, with advantages for the patient and for medical and nursing staff. However, nausea is reported to be a relatively common side effect, its incidence being similar to that seen with conventional intramuscular analgesia [I].When prescribing postoperative analgesia, it is common clinical practice to prescribe, in addition, antiemetic drugs as required, usually given intramuscularly or orally. However, there are potential drawbacks to both of these routes: intramuscular injections are painful and there is often an inevitable delay between need and administration, whilst oral antiemetics may not be absorbed and hence ineffective. It would therefore seem preferable to utilise the intravenous route which will exist if PCA is being employed. The use of antiemetic agents given with opioid analgesia might also have a prophylactic antiemetic effect. Droperidol has been shown to be an effective antiemetic agent in a number of clinical situations [2-4]. The present study was designed to assess the effectiveness of droperidol, given in conjunction with morphine PCA in reducing postoperative nausea and vomiting. MethodThis double-blind, randomised, prospective, placebocontrolled study was approved by the hospital ethics committee. Patients presenting for lumbar laminectomy were approached by the investigators to assess their suitability and consent for inclusion in the study. Patients who were pregnant, had a hiatus hernia or a clinical history that would suggest a significant risk of acid reflux were not studied. Any history of motion sickness or previous postoperative nausea and vomiting was noted. Patients giving informed consent were instructed in the use of a Baxter 'Infusor' PCA device and educated in the use of the pain and nausea scoring scales. A 10-point pain scale and a 5-point nausea scale were used in this study (Fig. 1). These scales were chosen because they were routinely in use on the neurosurgical wards and were therefore familiar to the nursing staff. The nursing staff were also instructe...

Use of the common gas outlet for the administration of supplemental oxygen during Caesarean section under regional anaesthesia*

“…The cost of 2.5 mg (1 ml) droperidol is £0.30; thus 2 days' infusion with PCA morphine will amount to £0.81-1.62, which is comparable with dexamethasone (£1.82 for 8 mg). However, droperidol may cause excessive drowsiness [34][35][36][37]. In our study, no discernible adverse effects accompanying dexamethasone administration were observed.…”

Nausea and vomiting in the postoperative patient‐controlled analgesia environment

“…However, Silverman et al [42] found the inclusion of promethazine with morphine PCA reduced nausea although the findings were dependent on the nausea scale used. Studies have found that the addition of droperidol (0.05-0.2 mg.ml ÿ 1 ) to morphine PCA has reduced the incidence of nausea and vomiting and, in some cases, the need for additional intramuscular anti-emetics [5,9,40,43,44]. However, some studies reported an increase in sedation associated with the use of droperidol [5,9,44] and Gan et al [45] argued that adding droperidol to PCA increases sedation with no benefit over a single dose of droperidol at the end of surgery.…”

“…Studies have found that the addition of droperidol (0.05-0.2 mg.ml ÿ 1 ) to morphine PCA has reduced the incidence of nausea and vomiting and, in some cases, the need for additional intramuscular anti-emetics [5,9,40,43,44]. However, some studies reported an increase in sedation associated with the use of droperidol [5,9,44] and Gan et al [45] argued that adding droperidol to PCA increases sedation with no benefit over a single dose of droperidol at the end of surgery. Moreover, although extrapyramidal side-effects were not reported in any of the studies, they should be considered, particularly if PCA is to continue beyond 24 h. Collum et al [46] report a case study of a patient experiencing a dystonic reaction Ϸ30 h after surgery and while receiving PCA morphine with droperidol 0.2 mg.ml ÿ 1 added.…”

“…Lerman [2] and Watcha & White [3] suggest that the incidence of postoperative nausea and vomiting has remained fairly constant for decades with Ϸ20-30% of patients suffering from these unpleasant side-effects. However, it is common to find reports of a much higher incidence in a variety of surgical populations [4][5][6][7][8][9][10]. Differentiation of opioidinduced nausea and vomiting from that of other perioperative factors, including those associated with uncontrolled pain [11], is difficult enough without complications introduced by patient-controlled analgesia (PCA) which allows patients to medicate on irregular and inconsistent bases.…”

Prevention of Postoperative Nausea and Vomiting in Gynaecological Laparotomies: A Comparison of Tropisetron and Ondansetron

“…We did not include droperidol, another commonly used antiemetic for prophylaxis of PONV, in our comparison. This was because of the side-effects reported with the use of this agent in patients receiving postoperative intravenous opioids, namely increased sedation and anxiety 22,23 . Recently we have shown that such effects might be minimized by using a less sedating opioid such as tramadol 24 and it might be interesting to compare the 5-HT 3 antagonists with droperidol in further studies in this context.…”