Abstract
Purpose
To determine whether low doses of droperidol mixed with morphine in patient-controlled analgesia (PCA) would extend the duration of prophylaxis against postoperative nausea and vomiting.
Methods
Healthy women having elective open-abdominal gynaecological surgery consented to this double-blind, place-bo-controlled study. Subjects were randomized to receive placebo, or 1 mg droperidol before induction followed by droperidol 0.0 (bolus group), 0.02 (0.02 group), or 0.04 (0.04 group) mg · mg−1 of PCA morphine. Study endpoints included severity of nausea, episodes of vomiting and rescue antiemetic doses, pain, and sedation and were assessed at 1, 2, 4, 8, 12, 16, 20 and 24 hr postoperatively.
Results
Seventy-one subjects completed the study. The groups were similar in age, weight, surgical time, pain scores, and morphine used. The 0.04 group had lower mean visual analogue scale scores for nausea (P < 0.05 vs all other groups). The incidence of vomiting was lower in all treatment groups (P < 0.05 for all groups vs placebo). The 0.04 group had lower rescue antiemetic requirements than the bolus group (P < 0.03). Mean sedation scores were tow in all groups but were increased with PCA droperidol (P < 0.02).
Conclusions
Droperidol 1 mg before induction of anaesthesia reduces postoperative vomiting. The addition of droperidol 0.04 mg · mg−1 of PCA morphine further reduces (i) severity of nausea and (ii) rescue antiemetic requirements postoperatively. No clinically significant side-effects were attributed to this regimen.
Résumé
Objectif
Établir si de faibles doses de dropéridol combinées à la morphine pour l’analgésie auto-contrôlée (PCA) pouvent prolonger la prévention antiémétique.
Méthodes
Des femmes en bonne santé soumises à une chirurgie gynécologique abdominale ouverte ont consenti à participer à cette étude en double aveugle et contrôlée avec placebo. Les patientes ont été réparties aléatoirement pour recevoir soit un placebo, soit dropéridol 1 mg avant l’induction suivi de dropéridol 0,0 (groupe bolus), 0,02 (groupe 0,02) ou 0,04 (groupe 0,04) mg · mg−1 de morphine en PCA. Les données recueillies portaient sur la gravité des nausées, les épisodes de vomissements et les doses d’antiémétiques de sauvetage, sur la douleur et la sédation, après 1, 2, 4, 8, 12, 16, 20 et 24 de l’intervention.
Résultats
Soixante et onze patientes ont complété l’étude. Les groupes étaient identiques quant à l’âge, le poids, la durée de la chirurgie, les scores de douleur et la morphine administrée. Le groupe 0,04 présentait les scores moyens les plus bas sur l’échelle visuelle analogique pour la nausée (P < 0,05) vs tous les autres groupes). L’incidence des vomissements était inférieure pour tous les groupe traités (P < 0,05 pour tous les groupes vs placebo). Le groupe 0,04 avait des besoins moins importants d’antiémétiques de sauvetage que le groupe bolus (P < 0,03). Les scores moyens de sédation étaient bas dans tous les groupes mais augmentaient avec le dropéridol en PCA (P < 0,02).
Conclusion
Le dropéridol 1 mg avant l’induction diminue les vomissements postopératoires. L’addition de dropéridol 0,04 mg · mg−1 à la morphine en PCA diminue encore plus (i) la gravité des nausées et (ii) les besoins d’antiémétiques de sauvetage postopératoires. Aucun effet secondaire important n ’a été noté.
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Klahsen, A.J., O’Reilly, D., McBride, J. et al. Reduction of post-operative nausea and vomiting with the combination of morphine and dropéridol in patient-controlled analgesia. Can J Anaesth 43, 1100–1107 (1996). https://doi.org/10.1007/BF03011835
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DOI: https://doi.org/10.1007/BF03011835