title: Influence of promethazine on symptom-therapy scores for nausea during patient-controlled analgesia with morphine.
abstract: We assessed whether adding promethazine to the syringe containing morphine for patient-controlled analgesia (PCA) decreases nausea after gynecologic surgery. Patients were assigned randomly to receive PCA (morphine 1.5 mg, 6-min lockout interval) with or without promethazine (0.625 mg/PCA dose, providing an average of 17.6 mg/24 h). Assessments included a visual analogue scale (VAS) for nausea (0 = none, 10 = worst possible) at scheduled times, rescue therapy requirements, and a maximum symptom-therapy score that provided an aggregate assessment of nausea intensity, duration, and response to rescue therapy (0 = no nausea; 1 = mild; 2 = moderate, requiring droperidol; 3 = severe or persistent, requiring droperidol; 4 = requiring droperidol+transdermal scopolamine; 5 = unrelieved). Nausea scores on the visual analogue scale at 2, 6, 8, and 24 h and use of rescue droperidol identified no significant differences between the groups. However, symptom-therapy scores differed significantly, with median values of 0 and 2, respectively, for the promethazine-treated and control groups. We conclude that simultaneous titration of morphine and promethazine decreases nausea associated with PCA therapy; the difference may best be appreciated with use of the combined symptom-therapy score.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
authors.forename: D G
authors.initials: DG
authors.lastname: Silverman
authors.forename: J
authors.initials: J
authors.lastname: Freilich
authors.forename: F B
authors.initials: FB
authors.lastname: Sevarino
authors.forename: D
authors.initials: D
authors.lastname: Paige
authors.forename: L
authors.initials: L
authors.lastname: Preble
authors.forename: T Z
authors.initials: TZ
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D004329:Droperidol / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009325:Nausea / Q000517:prevention & control*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control*; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D009020:Morphine; D011398:Promethazine; D004329:Droperidol