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Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery

Published online by Cambridge University Press:  29 August 2006

M. T. Aouad ,
S. M. Siddik-Sayyid ,
S. K. Taha ,
M. S. Azar ,
V. G. Nasr ,
M. A. Hakki ,
D. G. Zoorob  and
A. S. Baraka
M. T. Aouad
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
S. M. Siddik-Sayyid
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
S. K. Taha
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
M. S. Azar
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
V. G. Nasr
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
M. A. Hakki
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
D. G. Zoorob
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
A. S. Baraka
Affiliation:
American University of Beirut, Department of Anesthesiology, Medical Center, Beirut, Lebanon
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Abstract

Summary

Background and objective: Ondansetron is widely used for the prophylaxis of postoperative nausea and vomiting, while haloperidol is an antiemetic that lacks recent data on efficacy and adverse effects. Methods: In this prospective, randomized, double-blinded study involving 93 females undergoing gynaecological procedures under general anaesthesia, we compared the efficacy and adverse effects of prophylactic haloperidol 1 mg intravenous and ondansetron 4 mg intravenous vs. placebo. Results: During the overall observation period (0–24 h), in the haloperidol, ondansetron and placebo groups respectively, the incidence of nausea and/or vomiting was 40.7% (11/27), 48.2% (13/27) and 55.5% (15/27), and the need of rescue antiemetics was 22.2% (6/27), 44.4% (12/27) and 40.7% (11/27), with P values >0.05 among the three groups. During the early observation period (0–2 h), in the haloperidol, ondansetron and placebo groups respectively, the incidence of nausea and/or vomiting was 13.7% (4/29), 26.6% (8/30) and 43% (13/30), and the need for rescue antiemetics was 6.8% (2/29), 26.6% (8/30) and 36.6% (11/30). Between haloperidol and placebo groups, the P value was 0.04 for nausea and/or vomiting, and was 0.01 for rescue antiemetics, in addition to lower nausea scores (P = 0.03). During the late observation period (2–24 h), no significant difference was shown among the three groups. Conclusion: The prophylactic administration of 1 mg intravenous haloperidol or 4 mg ondansetron, in female patients undergoing gynaecological surgery, did not improve the overall incidence of nausea and/or vomiting vs. placebo. However, haloperidol 1 mg proved to be an effective antiemetic in the early observation period without significant adverse effects.

Keywords

ANAESTHESIA GENERAL, side-effectsPOSTOPERATIVE NAUSEA AND VOMITINGANTIEMETICS, SURGERY GYNAECOLOGICAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 2 , February 2007 , pp. 171 - 178
Copyright
2007 European Society of Anaesthesiology

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References

Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting. Anesthesiology 1999; 91: 693–700.Google Scholar
White PF, Song D, Abrao J, Klein KW, Navarette B. Effect of low dose droperidol on the QT interval during and after general anesthesia. Anesthesiology 2005; 102: 1101–1105.Google Scholar
Habib AS, Gan TJ. Food and drug administration black box warning on the perioperative use of droperidol: a review of the cases. Anesth Analg 2003; 96: 1377–1379.Google Scholar
White PF. Droperidol: a cost-effective antiemetic for over thirty years [Editorial]. Anesth Analg 2002; 95: 789–790.Google Scholar
Scuderi PE. You [still] can't disapprove the existence of 1dragons [Editorial]. Anesthesiology 2005; 102: 1081–1082.Google Scholar
Gan TJ, Meyer T, Apfel CCet al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 2003; 97: 62–71.Google Scholar
Baron MD, Libonati M, Cohen PJ. The use of haloperidol for treatment of postoperative nausea and vomiting: a double-blind placebo-controlled trial. Anesthesiology 1975; 42: 508–512.Google Scholar
Dyrberg V. Haloperidol [Serenase] in the prevention of postoperative nausea and vomiting. Acta Anaesthesiol Scand 1962; 6: 37–47.Google Scholar
Tornetta FJ. Double-blind evaluation of haloperidol for antiemetic activity. Anesth Analg 1972; 51: 964–967.Google Scholar
Büttner M, Walder B, Von Elm E, Tramèr M. Is low dose haloperidol a useful antiemetic? A meta-analysis of published and unpublished randomized trials. Anesthesiology 2004; 101: 1454–1463.Google Scholar
Critchley P, Plach N, Grantham Met al. Efficacy of haloperidol in the treatment of nausea and vomiting in the palliative patient: a systematic review. J Pain Symptom Manage 2001; 22: 631–634.Google Scholar
Parlow JL, Ioana C, Avery N, Turner K. Single-dose haloperidol for the prophylaxis of postoperative nausea and vomiting after intrathecal morphine. Anesth Analg 2004; 98: 1072–1076.Google Scholar
Taha S, Siddik-Sayyid S, Alameddine Met al. Propofol is superior to thiopental for intubation without muscle relaxants. Can J Anaesth 2005; 52: 349–353.Google Scholar
Melzack R. Measurement of nausea. J Pain Symptom Manage 1989; 4: 157–160.Google Scholar
Fortney JT, Gan TJ, Graczyk Set al. A comparison of the efficacy, safety, and patient satisfaction of ondansetron versus droperidol as antiemetics for elective outpatient surgical procedures. Anesth Analg 1998; 86: 731–738.Google Scholar
Apfel CC, Korttila K, Abdalla Met al. A factorial trial of six interventions for prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350: 2441–2451.Google Scholar
Eberhart LHJ, Mauch M, Morin AM, Wulf H, Geldner G. Impact of a multimodal antiemetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting. Anaesthesia 2002; 57: 1022–1027.Google Scholar
Sun R, Klein KW, White PF. The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth Analg 1997; 84: 331–336.Google Scholar
Graczyk SG, McKenzie R, Kallar Set al. Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg 1997; 84: 325–330.Google Scholar
Diemunsch P, Grelot L. Potential of substance P antagonists as antiemetics. Drugs 2000; 60: 533–546.Google Scholar
Diemunsch P, Schoeffler P, Bryssine Bet al. Antiemetic activity of NK1 receptor antagonist GR205171 in the treatment of established postoperative nausea and vomiting after major gynaecological surgery. Br J Anaesth 1999; 82: 274–276.Google Scholar
Habib AS, Gan TJ. The effectiveness of rescue antiemetics after failure of prophylaxis with ondansetron or droperidol: a preliminary report. J Clin Anesth 2005; 17: 62–65.Google Scholar
Charbit B, Albaladejo P, Funck-Brentano C, Legrand M, Samain E, Marty J. Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology 2005; 102: 1094–1100.Google Scholar
Lawrence KR, Nasraway SA. Conduction disturbances associated with administration of butyrophenone antipsychotics in the critically ill: a review of the literature. Pharmacotherapy 1997; 17: 531–537.Google Scholar
Sharma ND, Rosman HS, Pdhi ID, Tisdale JE. Torsades de pointes associated with intravenous haloperidol in critically ill patients. Am J Cardiol 1998; 81: 238–240.Google Scholar
Perrault LP, Denault AY, Carrier M, Cartier R, Belisle S. Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery. Can J Anaesth 2000; 47: 251–254.Google Scholar
Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything alright? JAMA 1983; 259: 1743–1745.Google Scholar
Tramèr MR, Reynolds DJM, Moore RA, Mc Quay HJ. Efficacy, dose–response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a qualitative systematic review of randomized placebo-controlled trials. Anesthesiology 1997; 87: 1277–1289.Google Scholar
Statile L, Puig MM, Warner W, Bansinath M, Lovitz M, Turndorf H. Droperidol enhances fentanyl and sufentanil, but not morphine, analgesia. Gen Pharmacol 1988; 19: 451–454.Google Scholar
Arcioni R, Della Rocca M, Romano S, Romano R, Pietropaoli P, Gasparetto A. Ondansetron inhibits the analgesic effects of tramadol: a possible 5-HT(3) spinal receptor involvement in acute pain in humans. Anesth Analg 2002; 94: 1553–1557.Google Scholar