Postoperative nausea and vomiting after surgery for prognathism: not only a question of patients' comfort. A placebo-controlled comparison of dolasetron and droperidol.
BACKGROUND
The aim of this study was to evaluate the efficacy of dolasetron and droperidol (DHB) for preventing postoperative nausea and vomiting (PONV) in patients undergoing surgery for prognathism.


METHODS
In a randomised, placebo-controlled, double-blind trial, the efficacy of 12.5 mg dolasetron i.v. and 1.25 mg DHB was evaluated in preventing PONV in 83 patients undergoing surgery for prognathism. Patients were allocated randomly to one of three groups: group A (n=27) received 12.5 mg dolasetron intravenously (i.v.), group B (n=27) received 1.25 mg DHB i.v. and placebo group C (n=29) received saline 0.9%. If patients complained of retching or vomiting or if patients demanded antiemetics, 20mg metoclopramide (MCP) i.v. was given. Postoperative nausea, postoperative vomiting, or nausea and vomiting was assessed in the postoperative period at 0-4 h and overall between 0 and 24 h.


RESULTS
A significant reduction in the incidence of postoperative nausea and/or vomiting was observed in the dolasetron group (33%) when compared with DHB (81%) and placebo (86%) treated patients. No other significant differences between the DHB and the placebo group were found. Dolasetron (11%) significantly reduced vomiting in comparison with the DHB (52%) and placebo group (52%). The use of postoperative MCP per patient was significantly lower in the dolasetron group when compared with both other groups. Dolasetron significantly reduced the postoperative nausea and/or vomiting-score when compared with both other groups. There was no significant difference between DHB- and placebo-treated patients with regard to nausea and/or vomiting.


CONCLUSIONS
Intravenous dolasetron (12.5 mg) is more effective than either intravenous DHB (1.25 mg) or placebo for preventing PONV after surgery for prognathism. It also was significantly superior to either DHB or placebo concerning nausea and vomiting and the need for MCP rescue medication.
Piper
Swen N
SN
Department of Anaesthesiology and Critical Care Medicine (Head: Prof. Dr. J. Boldt), Klinikum Ludwigshafen, Germany.
Röhm
Kerstin
K
Department of Anaesthesiology and Critical Care Medicine (Head: Prof. Dr. J. Boldt), Klinikum Ludwigshafen, Germany.
Boldt
Joachim
J
Department of Anaesthesiology and Critical Care Medicine (Head: Prof. Dr. J. Boldt), Klinikum Ludwigshafen, Germany.
Kranke
Peter
P
Department of Anaesthesiology and Critical Care Medicine (Head: Prof. Dr. N. Roewer), University of Würzburg, Germany.
Maleck
Wolfgang
W
Department of Anaesthesia (Head: Dr. S. Widjaja), Spital Menziken, Switzerland.
Seifert
Rudolf
R
Department of Maxillofacial Surgery (Head: Priv.-Doz. Dr. Dr. H. Umstadt), Klinikum Ludwigshafen, Germany.
Suttner
Stefan
S
Department of Anaesthesiology and Critical Care Medicine (Head: Prof. Dr. J. Boldt), Klinikum Ludwigshafen, Germany.
D000328:Adult; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004329:Droperidol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000145:classification / Q000517:prevention & control*; D011378:Prognathism / Q000601:surgery*; D011807:Quinolizines / Q000008:administration & dosage / Q000627:therapeutic use*; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000932:Antiemetics; D018492:Dopamine Antagonists; D007211:Indoles; D010919:Placebos; D011807:Quinolizines; D012702:Serotonin Antagonists; C060344:dolasetron; D008787:Metoclopramide; D004329:Droperidol