Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-18T08:56:04.508Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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