Droperidol has comparable clinical efficacy against both nausea and vomiting.

Author(s): Apfel CC, Cakmakkaya OS, Frings G, Kranke P, Malhotra A, Stader A, Turan A, Biedler A, Kolodzie K

Affiliation(s): Clinical Research Core, Department of Anesthesia and Perioperative Care, UCSF Mount Zion Hospital, University of California San Francisco, 1600 Divisadero Street, C-447, San Francisco, CA 94115, USA. apfelc@anesthesia.ucsf.edu

Publication date & source: 2009-09, Br J Anaesth., 103(3):359-63. Epub 2009 Jul 15.

Publication type: Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

BACKGROUND: Droperidol is commonly noted to be more effective at preventing postoperative nausea (PON) than vomiting (POV) and it is assumed to have a short duration of action. This may be relevant for clinical decisions, especially for designing multiple-drug antiemetic regimens. METHODS: We conducted a post hoc analysis of a large multicentre trial. Within this trial, 1734 patients underwent inhalation anaesthesia and were randomly stratified to receive several antiemetic interventions according to a factorial design, one of which was droperidol 1.25 mg vs placebo. We considered differences to be significant when: (i) point estimates of one outcome are not within the limits of the confidence interval (CI) of the other outcome; and (ii) differences in risk ratio (also known as relative risks, RR) are at least 20%. RESULTS: Over 24 h, nausea was reduced from 42.9% in the control to 32.0% in the droperidol group, corresponding to a relative risk (RR) of 0.75 (95% CI from 0.66 to 0.84). Vomiting was reduced from 15.6% to 11.8%, and therefore associated with a similar RR of 0.76 (0.59-0.96). In the early postoperative period (0-2 h), droperidol prevented nausea and vomiting similarly, with an RR of 0.57 (0.46-0.69) for nausea and 0.56 (0.37-0.85) for vomiting. In the late postoperative period (2-24 h), the RR was again similar with 0.83 (0.72-0.96) for nausea compared with 0.89 (0.66-1.18) for vomiting but significantly less compared with the early postoperative period. CONCLUSIONS: We conclude that droperidol prevents PON and POV equally well, yet its duration of action is short-lived.