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Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy

Abstract

Purpose: To determine the efficacy of ondansetron and droperidol, alone and in combination, administered for prophylaxis of postoperative nausea and vomiting (PONV) in women undergoing general anesthesia for out-patient gynecological laparoscopy.

Methods: Following Institutional Ethics Board approval and patient consent, 160 female out- patients scheduled for laparoscopy were randomly allotted in a double-blind fashion to receive: i) saline (placebo), ii) 4 mg ondansetron, iii) 1.25 mg droperidol, or iv) 4 mg ondansetron and 1.25 mg droperidol combination intravenously on induction. Following a standardized general anesthesia, patients were interviewed and assessed for PONV at various times.

Results: During the first 24 hr after surgery, the incidence of PONV in the placebo group was 71%. This was reduced to 61% with droperidol alone (P=0.334), to 46% with ondansetron alone (P=0.027), and to 23% with the combination group (P<0.001). A statistically significant difference was observed between combination and droperidol (P<0.001) and between combination and ondansetron (P=0.036). There were fewer requests for rescue medication from the combination group (7.7%) than from the ondansetron and placebo groups.

Conclusion: The results of this study suggest that the combination of 4 mg ondansetron and 1.25 mg droperidol is more efficacious as a prophylactic anti-emetic than either agent alone during the 24 hr post-surgery. This additive effect may be due to the different mechanisms of action of ondansetron and droperidol.

Résumé

Objectif: Déterminer l’efficacité de l’ondansétron et du dropéridol, seuls ou combinés, administrés comme prophylaxie des nausées et vomissements postopératoires (NVPO) chez des patientes sous anesthésie générale lors d’une laparoscopie gynécologique en clinique externe.

Méthode: Après avoir obtenu l’autorisation du Comité d’éthique médicale et le consentement des patientes, on a procédé à l’étude de 160 femmes, réparties au hasard en double aveugle, qui ont reçu avant la laparoscopie ambulatoire prévue: i) une solution salée (placebo), ii) 4 mg d’ondansétron, iii) 1,25 mg de dropéridol, ou iv) une combinaison intraveineuse de 4 mg d’ondansétron et de 1,25 mg de dropéridol à l’induction de l’anesthésie. Après l’anesthésie générale standard, les patientes ont été interrogées sur les NVPO à différents temps.

Résultats: Pendant les 24 premières heures postopératoires, l’incidence des NVPO ont été de 71 % dans le groupe placebo. Cette incidence a été réduite à 61 % avec de dropéridol employé seul (P=0,334), à 46 % avec l’ondansétron seul (P=0,027) et à 23 % avec la combinaison des deux médicaments (P<0,001). Une différence statistiquement différente a été observée entre la combinaison et le dropéridol (P<0,001) et entre la combinaison et l’ondansétron (P=0,036). On enregistre moins de demandes de médication de rattrapage provenant des patientes qui ont reçu la combinaison de médicaments (7,7 %) que de celles qui ont reçu l’ondansétron ou le placebo.

Conclusion: Les résultats de l’étude suggèrent que la combinaison de 4 mg d’ondansétron et de 1,25 mg de dropéridol est plus efficace comme prophylaxie antiémétique que chacun des médicaments utilisés seuls pendant les 24 premières heures postopératoires. Cet effet additionnel pourrait être attribué aux différents mécanismes d’action de l’ondansétron et du dropéridol.

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Correspondence to Susan E. Belo PhD MD FRCPC.

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This work was supported by St. Michael’s Hospital Health Science Research Center, Toronto and in part by Glaxo, Inc. of Canada, Mississauga, Ontario, Canada.

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Wu, O., Belo, S.E. & Koutsoukos, G. Additive anti-emetic efficacy of prophylactic ondansetron with droperidol in out-patient gynecological laparoscopy. Can J Anesth 47, 529–536 (2000). https://doi.org/10.1007/BF03018944

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Keywords

  • Ondansetron
  • Visual Analog Scale Score
  • Combination Group
  • Droperidol
  • Motion Sickness