A randomized comparison of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting.
A multimodal management strategy for the prevention of postoperative nausea and vomiting (PONV) appears to be superior to single-drug prophylaxis. We tested the hypothesis that a multimodal PONV prophylaxis regimen incorporating total IV anesthesia (TIVA) with propofol and a combination of ondansetron and droperidol is more effective than a combination of these antiemetics in the presence of an inhaled anesthetic. Ninety patients undergoing laparoscopic cholecystectomy were randomized to one of three groups. Group 1 (multimodal group) received TIVA with propofol, droperidol, and ondansetron. Group 2 (combination group) received droperidol and ondansetron with isoflurane and nitrous oxide for the maintenance of anesthesia. Group 3 (TIVA group) received propofol for the induction and maintenance of anesthesia. The complete response rate (no PONV and no rescue antiemetic) at 2 h after surgery was 90%, 63%, and 66% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 2). At 24 h, the complete response rate was 80%, 63%, and 43% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 3). Patient satisfaction was also greater in the multimodal group than in the other two groups in the postanesthesia care unit (P < 0.05). In conclusion, the multimodal management strategy for PONV was associated with a higher complete response rate and greater patient satisfaction when compared with similar antiemetic prophylaxis with inhaled anesthesia or TIVA with propofol.
Departments of *Anesthesiology and †Surgery, Duke University Medical Center, Durham, North Carolina.
Ashraf S
AS
Habib
William D
WD
White
Steve
S
Eubanks
Theodore N
TN
Pappas
Tong J
TJ
Gan
D000328:Adult; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004329:Droperidol / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000009:adverse effects; D017294:Ondansetron / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000175:diagnosis / Q000517:prevention & control*; D015742:Propofol / Q000009:adverse effects
D018686:Anesthetics, Intravenous; D000932:Antiemetics; D004338:Drug Combinations; D017294:Ondansetron; D007530:Isoflurane; D009609:Nitrous Oxide; D004329:Droperidol; D015742:Propofol