Cyclizine and droperidol have comparable efficacy and side effects during patient-controlled analgesia.
BACKGROUND
Post-operative nausea and vomiting (PONV) is common, especially following gynaecological surgery. Patient-controlled analgesia (PCA) is frequently complicated by nausea. We assessed PONV, pain and sedation in patients receiving cyclizine or droperidol during PCA following abdominal hysterectomy in a double-blind trial.


METHODS
Thirty women were randomised to receive either cyclizine 0.7 mg/kg or droperidol 0.04 mg/kg during surgery followed by PCA containing morphine sulphate with cyclizine 2 mg or droperidol 0.05 mg per demand. Blinded observers scored levels of nausea, sedation, anxiety and pain.


RESULTS
Pain scores, PCA usage and supplemental antiemetic requirements were comparable. Nausea and sedation scores were similar in both groups. Two patients in each group developed refractory PONV. Pre-operative anxiety scores were similar and decreased comparably over time. Patients developing refractory emetic sequelae had a higher incidence of previous PONV. Previous PONV also predicted lower PCA medication intake despite similar demand rates, suggesting increased usage during lock-out periods.


CONCLUSIONS
Prophylactic cyclizine and droperidol have similar efficacy during PCA. Neither is associated with perioperative anxiety. A minority of patients have refractory PONV during PCA. Previous PONV may predict less efficient PCA usage.
Laffey
J G
JG
Department of Anaesthesia, St Vincent's University Hospital, Dublin, Ireland.
Boylan
J F
JF
D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000932:Antiemetics / Q000009:adverse effects; D001007:Anxiety / Q000517:prevention & control; D003501:Cyclizine / Q000009:adverse effects; D004311:Double-Blind Method; D004329:Droperidol / Q000009:adverse effects; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology* / Q000517:prevention & control; D011292:Premedication
D000701:Analgesics, Opioid; D000932:Antiemetics; D009020:Morphine; D004329:Droperidol; D003501:Cyclizine
Clin Pharmacol Ther. 1986 May;39(5):489-90
3698457
Can J Anaesth. 1998 Oct;45(10):943-8
9836030
Anesth Analg. 1999 Jun;88(6):1354-61
10357345
Anesth Analg. 1989 Dec;69(6):748-51
2589655
JAMA. 1988 Jan 8;259(2):243-7
3275811
Anesthesiology. 1996 Aug;85(2):260-9
8712440
Anaesthesia. 1997 Aug;52(8):770-5
9291763
Br J Anaesth. 1996 Mar;76(3):347-51
8785131
Anaesthesia. 1995 Jul;50(7):654-6
7653770
Anesthesiology. 1999 Sep;91(3):693-700
10485781
Can Anaesth Soc J. 1984 Mar;31(2):178-87
6367902
Anesth Analg. 1969 Jan-Feb;48(1):136-40
5812547
J Am Geriatr Soc. 1992 Sep;40(9):922-35
1512391