The Efficacy of Prophylactic Ondansetron, Droperidol, Perphenazine, and Metoclopramide in the Prevention of Nausea and Vomiting After Major Gynecologic Surgery

• Published in: Anesthesia and analgesia Vol. 81; no. 1; pp. 139 - 143
• Main Authors: Desilva, P. H. D. P., Darvish, Amir H., McDonald, Steven M., Cronin, Mary K., Clark, Kathy
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.07.1995; Lippincott
• Subjects: Akathisia, Drug-Induced - etiology; Biological and medical sciences; Consciousness - drug effects; Digestive system; Double-Blind Method; Droperidol - administration & dosage; Droperidol - adverse effects; Droperidol - therapeutic use; Female; Humans; Hypotension - chemically induced; Hysterectomy - adverse effects; Injections, Intravenous; Medical sciences; Metoclopramide - administration & dosage; Metoclopramide - adverse effects; Metoclopramide - therapeutic use; Middle Aged; Nausea - prevention & control; Ondansetron - administration & dosage; Ondansetron - adverse effects; Ondansetron - therapeutic use; Perphenazine - administration & dosage; Perphenazine - therapeutic use; Pharmacology. Drug treatments; Placebos; Postoperative Complications - prevention & control; Prospective Studies; Vomiting - prevention & control; Human; Postoperative; Intravenous administration; Gynecology; Butyrophenone derivatives; Nausea; Phenothiazine derivatives; Prevention; Chemotherapy; Vomiting; Surgery; Digestive diseases; Female; Antiemetic
• ISSN: 0003-2999
• DOI: 10.1097/00000539-199507000-00028

The prophylactic antiemetic efficacy of intravenous (IV) ondansetron, droperidol, perphenazine, and metoclopramide was evaluated in a prospective, doubleblind study of 360 ASA physical status I-III patients undergoing total abdominal hysterectomy (TAH). Subjects were randomized to receive IV, one of ondansetron 4 mg, droperidol 1.25 mg, perphenazine 5 mg, metoclopramide 10 mg, or placebo prior to induction of anesthesia. Hypotension immediately after administration of metoclopramide was observed in two patients and four patients given ondansetron developed profound systolic hypotension at induction of anesthesia. Twenty-two percent of patients receiving droperidol became sedated. Postoperatively, patients developing severe nausea, retching, or vomiting, defined as severe emetic sequelae (SES), were deemed to have failed antiemetic prophylaxis and received antiemetic rescue. A significantly larger number of patients who received IV ondansetron (63%), droperidol (76%), and perphenazine (70%) were free of SES when compared to placebo (43%); P < 0.05. Metoclopramide was ineffective. Although ondansetron, droperidol, and perphenazine were effective in providing antiemetic prophylaxis, only IV perphenazine was free of side effects. Hence, we conclude that perphenazine is the best choice for antiemetic prophylaxis after TAH.(Anesth Analg 1995;81:139-43)