Skip to main content
Download PDF

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

Canadian Journal of Anesthesia volume 47, pages 529–536 (2000)Cite this article

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.

References

  1. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–84.

    PubMed  Article  CAS  Google Scholar 

  2. Hovorka J, Korttila K, Erkola O. Nitrous oxide does not increase nausea and vomiting following gynaecological laparoscopy. Can J Anaesth 1989; 36: 145–8.

    PubMed  CAS  Article  Google Scholar 

  3. White PF, Shafer A Nausea and vomiting: causes and prophylaxis. Semin Anesth 1987; 6: 300–8.

    Google Scholar 

  4. Hirsh J. Impact of postoperative nausea and vomiting in the surgical setting. Anaesthesia 1994; 49(Suppl): 30–3.

    Article  Google Scholar 

  5. Stockall CA. Postoperative nausea and vomiting — when will it stop? (Editorial) Can J Anesth 1999; 46: 715–8.

    PubMed  CAS  Google Scholar 

  6. Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia 1994; 49(Suppl): 2–5.

    PubMed  Article  Google Scholar 

  7. Peroutka SJ, Snyder SH. Antiemetics: neurotransmitter receptor binding predicts therapeutic action. Lancet 1982; 1: 658–9.

    PubMed  Article  CAS  Google Scholar 

  8. Riley TJ, McKenzie R, Tantisira BR, Hamilton DL. Droperidol-ondansetron combinationversus droperidol alone for postoperative control of emesis after total abdominal hysterectomy. J Clin Anesth 1998; 10: 6–12.

    PubMed  Article  CAS  Google Scholar 

  9. Simpson RB, Russell D. Anaesthesia for daycase gynaecological laparoscopy: a survey of clinical practice in the United Kingdom. Anaesthesia 1999; 54: 51–85.

    Article  Google Scholar 

  10. Bodner M, White PF. Antiemetic efficacy of ondansetron after outpatient laparoscopy. Anesth Analg 1991; 73: 250–4.

    PubMed  Article  CAS  Google Scholar 

  11. Dupeyron JP, Conseiller C, Levarlet M, et al. The effect of oral ondansetron in the prevention of postoperative nausea and vomiting after major gynaecological surgery performed under general anaesthesia. Anaesthesia 1993; 48: 214–8.

    PubMed  Article  CAS  Google Scholar 

  12. Kenny GNC, Oates JDL, Leeser J, et al. Efficacy of orally administered ondansetron in the prevention of post-operative nausea and vomiting: a dose ranging study. Br J Anaesth 1992; 68: 466–70.

    PubMed  Article  CAS  Google Scholar 

  13. Russell D, Kenny GNC. 5-HT3 antagonists in postoperative nausea and vomiting. Br J Anaesth 1992; 69: 63S-8S.

    PubMed  Article  CAS  Google Scholar 

  14. Wadibia EC. Antiemetics. South Med J 1999; 92: 162–5.

    PubMed  Article  CAS  Google Scholar 

  15. McKenzie R, Uy NTL, Riley TJ, Hamilton DL. Droperidol/ondansetron combination controls nausea and vomiting after tubal banding. Anesth Analg 1996; 83: 1218–22.

    PubMed  Article  CAS  Google Scholar 

  16. Tang J, Watcha MF, White PF. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 1996; 83: 304–13.

    PubMed  Article  CAS  Google Scholar 

  17. Fortney JT, Gan TJ, Graczyk S, et 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: 731–8.

    PubMed  Article  CAS  Google Scholar 

  18. Beattie WS, Lindblad T, Buckley DN, Forrest JB. Menstruation increases the risk of nausea and vomiting after laparoscopy. Anesthesiology 1993; 78: 272–6.

    PubMed  Article  CAS  Google Scholar 

  19. Koivuranta M, Jokela R, Kiviluoma K, Alahuhta S. The anti-emetic efficacy of a combination of ondansetron and droperidol. Anaesthesia 1997; 52: 863–8.

    PubMed  Article  CAS  Google Scholar 

  20. Myles PS, Hendrata M, Bennett AM, Langley M, Buckland MR. Postoperative nausea and vomiting. Propofol or thiopentone: does choice of induction agent affect outcome? Anaesth Intensive Care 1996; 24: 355–9.

    PubMed  CAS  Google Scholar 

  21. Pueyo, F J, Carrascosa F, Lopez L, Irbarren MJ, Garcia-Pedrajas F, Saez A. Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting. Anesth Analg 1996; 83: 117–22.

    PubMed  Article  CAS  Google Scholar 

  22. Wrench IJ, Ward JEH, Walder AD, Hobbs GJ. The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol. Anaesthesia 1996; 51: 776–8.

    PubMed  CAS  Google Scholar 

  23. Goodman NW. Trials of postoperative antiemetics need three arms (Letter). BMJ 1999; 318: 942.

    PubMed  CAS  Google Scholar 

  24. Cohen SE, Woods WA, Wyner J. Antiemetic efficacy of droperidol and metoclopramide. Anesthesiology 1984; 60: 67–9.

    PubMed  CAS  Google Scholar 

  25. Fischler M, Bonnet F, Trang H, et al. The pharmacokinetics of droperidol in anesthetized patients. Anesthesiology 1986; 64: 486–9.

    PubMed  CAS  Article  Google Scholar 

  26. Pritchard JF, Bryson JC, Kernodle AE, Benedetti TL, Powell JR. Age and gender effects on ondansetron pharmacokinetics: evaluation of healthy aged volunteers. Clin Pharmacol Ther 1992; 51: 51–5.

    PubMed  CAS  Google Scholar 

  27. Sniadach MS, Alberts MS. A comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy. Anesth Analg 1997; 85: 797–800.

    PubMed  Article  CAS  Google Scholar 

  28. Tramèr MR, Reynolds DJM, Moore RA, McQuay HJ. When placebo controlled trials are essential and equivalence trials are inadequate. BMJ 1998; 317: 875–80.

    PubMed  Google Scholar 

  29. Khalil SN, Kataria B, Pearson K, et al. Ondansetron prevents postoperative nausea and vomiting in women outpatients. Anesth Analg 1994; 79: 845–51.

    PubMed  Article  CAS  Google Scholar 

  30. McKenzie R, Kovac A, O’Connor T, et al. Comparison of ondansetronversus placebo to prevent postoperative nausea and vomiting in women undergoing ambulatory gynecologic surgery. Anesthesiology 1993; 78: 21–8.

    PubMed  Article  CAS  Google Scholar 

  31. Broomhead CJ. Physiology of postoperative nausea and vomiting. Br J Hosp Med 1995; 53: 327–30.

    PubMed  CAS  Google Scholar 

  32. Sebel PS, Lowdon JD. Propofol: a new intravenous anesthetic. Anesthesiology 1989; 71: 260–77.

    PubMed  Article  CAS  Google Scholar 

  33. Di Florio T, Goucke CR. The effect of midazolam on persistent postoperative nausea and vomiting. Anesth Intensive Care 1999; 27: 38–40.

    Google Scholar 

  34. Kenny GNC. Risk factors for postoperative nausea and vomiting. Anaesthesia 1994; 49(Suppl): 6–10.

    PubMed  Article  Google Scholar 

  35. Palazzo M, Evans R Logistic regression analysis of fixed patient factors for postoperative sickness: a model for risk management. Br J Anaesth 1993; 70: 135–40.

    PubMed  Article  CAS  Google Scholar 

  36. Wrench IJ, Ward JE, Walder AD, Hobbs GJ. The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol. Anaesthesia 1996; 51: 776–8.

    PubMed  CAS  Google Scholar 

  37. Warrick PD, Belo SE. Treating rebound emesis following outpatient gynecologic laparoscopy: the efficacy of a two-dose regimen of droperidol and ondansetron. J Clin Anesth 1999; 11: 119–25.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the Department of Pharmacology, University of Toronto, Canada

    Olivia Wu BSc, Susan E. Belo PhD MD FRCPC & Georgios Koutsoukos MSc

  2. Department of Anaesthesia, St. Michael’s Hospital, 30 Bond Street, M5B 1W8, Toronto, Ontario, Canada

    Olivia Wu BSc, Susan E. Belo PhD MD FRCPC & Georgios Koutsoukos MSc

Authors
  1. Olivia Wu BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susan E. Belo PhD MD FRCPC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georgios Koutsoukos MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan E. Belo PhD MD FRCPC.

Additional information

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.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03018944

Keywords

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