Dose-ranging effect of systemic diphenhydramine on postoperative quality of recovery after ambulatory laparoscopic surgery: a randomized, placebo-controlled, double-blinded, clinical trial

• Published in: Journal of clinical anesthesia Vol. 34; pp. 46 - 52
• Main Authors: De Oliveira, Gildasio S., Bialek, Jane, Marcus, R.-J., McCarthy, Robert
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Administration, Intravenous; Adult; Ambulatory; Ambulatory Surgical Procedures - adverse effects; Ambulatory Surgical Procedures - methods; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia & Perioperative Care; Antiemetics - administration & dosage; Clinical trials; Diphenhydramine; Diphenhydramine - administration & dosage; Double-Blind Method; Drug dosages; Female; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Humans; Laparoscopy; Laparoscopy - adverse effects; Length of Stay; Middle Aged; Narcotics; Nausea; Pain; Pain Measurement; Pain Medicine; Pain, Postoperative - prevention & control; Patients; Placebo effect; Postoperative Nausea and Vomiting - prevention & control; Postoperative Period; Prospective Studies; Quality; Questionnaires; Recovery; Recovery (Medical); Surgery; Vomiting; Ambulatory; Diphenhydramine; Recovery; Quality; Surgery
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.03.046

Diphenhydramine is an antihistamine with previously demonstrated analgesic and antiemetic properties. However, it is unknown if the beneficial perioperative properties of diphenhydramine can translate to a better quality of postsurgical recovery. The main objective of the current investigation was to investigate dose-ranging effects of diphenhydramine on quality of recovery after surgery. Tertiary hospital in the United States. A prospective, randomized, double-blind trial. Saline, diphenhydramine 25 >mg, or diphenhydramine 50 mg given intravenously before induction. The primary outcome was global Quality of Recovery–40 at 24hours. Postoperative pain, nausea, opioid consumption, and discharge time were also evaluated. Ninety subjects were randomized, and 75 completed the study. The median (interquartile range) Quality of Recovery–40 scores were not different among study groups: 164 (151-189), 169 (159-181), and 172 (157-185) for the saline, 25-mg diphenhydramine, and 50-mg diphenhydramine groups, respectively (P=.74). Postoperative nausea was decreased in the 50-mg group, 3 of 24 (12.5%), compared with the saline group, 12 of 27 (44%), P=.01. There was an inverse linear association between postoperative opioid consumption and quality of recovery (R2=0.37, P<.001). Diphenhydramine does not provide dose-ranging improvements on postoperative quality of recovery after ambulatory laparoscopic gynecologic surgery. Our results support a recent concept that not all postoperative nausea and vomiting symptoms are clinically important. Future studies evaluating postoperative nausea and vomiting should include patient-centered outcomes to validate the clinical importance of the examined interventions. •Diphenhydramine has analgesic and antiemetic properties.•However, it is unknown if diphenhydramine can improve postsurgical recovery.•Diphenhydramine did not improve quality of recovery after ambulatory surgery.•Not all postoperative nausea and vomiting symptoms are clinically important.