Comparison of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia.
In a randomised, placebo-controlled trial we have compared the efficacy of ondansetron and droperidol in reducing postoperative nausea and vomiting associated with patient-controlled analgesia after orthopaedic surgery. One hundred and forty five patients, ASA 1 and 2, undergoing major orthopaedic surgery were anaesthetised using a standardised technique. They were randomly allocated to receive patient-controlled analgesia as morphine 1 mg.ml-1 alone; morphine as before plus a single dose of 1.25 mg droperidol together with 0.083 mg.ml-1 in the infusion syringe; or morphine as before plus 4 mg ondansetron and 0.13 mg.ml-1 in the syringe. The patient-controlled analgesia bolus dose was set at 1 ml with a 5 min lockout and a 4 h maximum dose of 30 mg morphine. There was no background infusion. The occurrence of nausea, vomiting and sedation was assessed every 4 h. The incidence of vomiting decreased from 59% in the morphine-only group to 35% and 14% in the droperidol (p < 0.05) and ondansetron groups (p < 0.001) respectively. The number of patients suffering from nausea alone was not significantly different between the three groups, although those in the ondansetron group experienced less severe nausea (p < 0.05) when using a two point scale. The droperidol group had significantly higher sedation scores than the other two groups (p < 0.005). We conclude that ondansetron is superior to droperidol when used with patient-controlled analgesia and causes less sedation.
Department of Anaesthetics, Royal National Orthopaedic Hospital, Stanmore, Middlesex.
R
R
Alexander
A T
AT
Lovell
D
D
Seingry
R M
RM
Jones
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use*; D004329:Droperidol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects*; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D017294:Ondansetron / Q000627:therapeutic use*; D009985:Orthopedics; D011183:Postoperative Complications / Q000517:prevention & control; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000932:Antiemetics; D017294:Ondansetron; D009020:Morphine; D004329:Droperidol