Superior prolonged antiemetic prophylaxis with a four-drug multimodal regimen - comparison with propofol or placebo.
BACKGROUND
The purpose of this study was to compare the effects of a low-dose propofol infusion with a four-drug multimodal regimen for prophylaxis of postoperative nausea and vomiting (PONV).


METHODS
: PONV was studied in two patient groups with a known high incidence. Through a stratified randomization, 60 patients undergoing breast surgery and 120 patients undergoing abdominal surgery were randomized to three groups of equal size: the propofol group (P), the multidrug group (M) and the control group (C). All patients received general anesthesia, induction with propofol and maintenance with sevoflurane. After induction, patients in the P group received a continuous infusion of propofol 1 mg/kg/h during the operation and the first 4 postoperative h. Patients in the M group received dexamethasone 4 mg and three antiemetics, ondansetron 4 mg, droperidol 1.25 mg and metoclopramide 10 mg i.v. In the control group no prophylaxis was given. Nausea and pain were evaluated by incidence and a visual analog scale (0-10 cm). All emetic episodes were noted by the staff during the first 4 h and by the patients during the next 20 h.


RESULTS
The overall incidence of PONV during the first 24 h postoperatively was significantly lower in the M group (24%) than in the P group (49%) (P<0.01) or the C group (70%) (P<0.001). The incidence of PONV increased significantly both in patients undergoing breast surgery and abdominal surgery after termination of propofol. The number of patients who vomited was significantly lower in the M group, both in breast surgery patients (5%) and abdominal surgery patients (3%) compared to patients in the propofol groups (breast 16% NS; abdominal 29%, P<0.05) and in the control groups (breast 37%, P<0.01; abdominal 29%, P<0.01).


CONCLUSIONS
The incidence of PONV is very high in patients undergoing breast and abdominal surgery. In the present study antiemetic prophylaxis with a combination of droperidol, ondansetron, metoclopramide and dexamethasone was more effective in preventing PONV, especially vomiting, than a postoperative low-dose infusion of propofol, which had a short lasting effect.
Hammas
B
B
Department of Anesthesia and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden.
Thörn
S-E
SE
Wattwil
M
M
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000932:Antiemetics / Q000008:administration & dosage*; D001940:Breast / Q000601:surgery; D003907:Dexamethasone / Q000008:administration & dosage; D004329:Droperidol / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage; D008875:Middle Aged; D017294:Ondansetron / Q000008:administration & dosage; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*
D000932:Antiemetics; D017294:Ondansetron; D003907:Dexamethasone; D008787:Metoclopramide; D004329:Droperidol; D015742:Propofol