title: Post discharge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis.
abstract: OBJECTIVE
  To determine the incidence of post-discharge nausea and vomiting (PDNV) following outpatient laparoscopic procedures in women, and to assess the efficacy of the prophylactic administration of promethazine prior to discharge from hospital.
  
  
  METHODS
  Ninety-five healthy women scheduled for ambulatory laparoscopic cholecystectomy or gynecological surgery completed this double blind, placebo controlled study. A standardized fentanyl-propofol-nitrous oxide-isoflurane anesthetic was used, and all patients received 0.5 mg droperidol i.v., intraoperatively. Subjects were randomized to receive 0.6 mg x kg(-1) promethazine or placebo i.m. prior to transfer from the post-anesthetic recovery (PAR) unit. The incidence and severity of nausea, pain, and drowsiness were documented using patient diaries at four time intervals during the first 24 hr postoperatively using four-point self-assessment scales.
  
  
  RESULTS
  After discharge home, the overall incidence of nausea was 48%, moderate to severe nausea 30%, vomiting 17% and rescue antiemetic use 28%, with no difference between those receiving saline or promethazine. The need for antiemetics in the PAR was associated with subsequent PDNV, with those requiring PAR antiemetics being four times as likely to vomit after discharge (P = 0.008).
  
  
  CONCLUSIONS
  Despite the prophylactic administration of 0.5 mg droperidol i.v., patients undergoing ambulatory laparoscopic surgery reported a high incidence of nausea after discharge. Patients requiring antiemetics in the PAR were at higher risk for PDNV. The incidence of nausea was not altered by prophylactic administration of 0.6 mg x kg(-1) promethazine i.m. before discharge.
authors.affiliation: Department of Anesthesiology and Critical Care, Queen's University, Ontario, Canada. parlowj@post.queensu.ca
authors.forename: J L
authors.initials: JL
authors.lastname: Parlow
authors.forename: A T
authors.initials: AT
authors.lastname: Meikle
authors.forename: J
authors.initials: J
authors.lastname: van Vlymen
authors.forename: N
authors.initials: N
authors.lastname: Avery
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures; D000932:Antiemetics / Q000627:therapeutic use*; D002763:Cholecystectomy / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced / Q000523:psychology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D011398:Promethazine / Q000627:therapeutic use*; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D000932:Antiemetics; D011398:Promethazine