Dose-ranging effect of systemic diphenhydramine on postoperative quality of recovery after ambulatory laparoscopic surgery: a randomized, placebo-controlled, double-blinded, clinical trial.
OBJECTIVE
Diphenhydramine is an antihistamine with previously demonstrated analgesic and antiemetic properties. However, it is unknown if the beneficial perioperative properties of diphenhydramine can translate to a better quality of postsurgical recovery. The main objective of the current investigation was to investigate dose-ranging effects of diphenhydramine on quality of recovery after surgery.


METHODS
Tertiary hospital in the United States.


METHODS
A prospective, randomized, double-blind trial.


METHODS
Saline, diphenhydramine 25 >mg, or diphenhydramine 50 mg given intravenously before induction.


METHODS
The primary outcome was global Quality of Recovery-40 at 24hours. Postoperative pain, nausea, opioid consumption, and discharge time were also evaluated.


RESULTS
Ninety subjects were randomized, and 75 completed the study. The median (interquartile range) Quality of Recovery-40 scores were not different among study groups: 164 (151-189), 169 (159-181), and 172 (157-185) for the saline, 25-mg diphenhydramine, and 50-mg diphenhydramine groups, respectively (P=.74). Postoperative nausea was decreased in the 50-mg group, 3 of 24 (12.5%), compared with the saline group, 12 of 27 (44%), P=.01. There was an inverse linear association between postoperative opioid consumption and quality of recovery (R(2)=0.37, P<.001).


CONCLUSIONS
Diphenhydramine does not provide dose-ranging improvements on postoperative quality of recovery after ambulatory laparoscopic gynecologic surgery. Our results support a recent concept that not all postoperative nausea and vomiting symptoms are clinically important. Future studies evaluating postoperative nausea and vomiting should include patient-centered outcomes to validate the clinical importance of the examined interventions.
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University. Electronic address: g-jr@northwestern.edu.
Gildasio S
GS
De Oliveira
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University.
Jane
J
Bialek
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University.
R-J
RJ
Marcus
Department of Anesthesiology, Feinberg School of Medicine, Northwestern University.
Robert
R
McCarthy
D061605:Administration, Intravenous; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000932:Antiemetics / Q000008:administration & dosage*; D004155:Diphenhydramine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011184:Postoperative Period; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000932:Antiemetics; D004155:Diphenhydramine
Ambulatory; Diphenhydramine; Quality; Recovery; Surgery