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Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial

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Abstract

Purpose

Postoperative nausea and vomiting (PONV) and pain following bariatric surgery are problematic and affect the outcome of patients. Intraoperative multimodal antiemetic prophylaxis is essential to improve postoperative outcomes. This study investigated the effect of adding diphenhydramine to acetaminophen and ondansetron in reducing postoperative nausea and vomiting and pain following laparoscopic sleeve gastrectomy (LSG).

Materials and Methods

Eighty-two patients scheduled for LSG were assigned to receive a single preinduction dose of diphenhydramine 0.4 mg/kg VI (D group) in addition to acetaminophen 1g and ondansetron 4 mg IV at the end of surgery and just acetaminophen 1 g and ondansetron 4 mg IV (C group) in a randomized, double-blind trial. PONV was assessed in recovery and 24 hours after surgery in the ward. Postoperative pain, analgesic requirements, and patients’ level of sedation were also assessed.

Results

The PONV rates in the recovery of the D group and the C group were 30% and 56% (P = .001). It also had a more significant reduction in the D group than in the C group in the first 24 h after surgery (40% vs. 66%). The severity of pain score and level of sedation and analgesic requirements was significantly reduced in this period in the D group.

Conclusion

Prophylactic diphenhydramine 0.4 mg/kg at the induction of general anesthesia in combination with acetaminophen 1 g and ondansetron 4 mg at the end of surgery reduced the incidence of PONV and postoperative severity of pain in laparoscopic sleeve gastrectomy.

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Acknowledgements

We are indebted to the research and development center of Sina Hospital for their support.

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Authors and Affiliations

  1. Department of Anesthesiology, Sina Hospital, Tehran University of Medical Sciences, Imam Khomeini St, Tehran, 11367-46911, Iran

    Pejman Pourfakhr, Mojtaba Aghabagheri & Mohammad Reza Khajavi

  2. Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Hossein Zabihi Mahmoudabadi, Khosrow Najjari & Mohammad Talebpour

Authors
  1. Pejman Pourfakhr
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  2. Mojtaba Aghabagheri
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  3. Hossein Zabihi Mahmoudabadi
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  4. Khosrow Najjari
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  5. Mohammad Talebpour
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  6. Mohammad Reza Khajavi
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Corresponding author

Correspondence to Mohammad Reza Khajavi.

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Key Points

- PONV is a highly common postoperative complication among patients undergoing LSG.

- Intraoperative multimodal antiemetic prophylaxis is important to improve postoperative outcomes.

- Diphenhydramine with central and peripheral antihistamine and anticholinergic properties has some potential antiemetic and analgesic activity.

- Diphenhydramine at the general anesthesia induction plus acetaminophen and ondansetron at the end of surgery reduced the PONV and pain in LSG.

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Pourfakhr, P., Aghabagheri, M., Zabihi Mahmoudabadi, H. et al. Prophylactic Administration of Diphenhydramine/Acetaminophen and Ondansetron Reduced Postoperative Nausea and Vomiting and Pain Following Laparoscopic Sleeve Gastrectomy: a Randomized Controlled Trial. OBES SURG 31, 4371–4375 (2021). https://doi.org/10.1007/s11695-021-05589-2

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  • DOI: https://doi.org/10.1007/s11695-021-05589-2

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