Post discharge nausea and vomiting after ambulatory laparoscopy is not reduced by
promethazine prophylaxis.
Author(s): Parlow JL, Meikle AT, van Vlymen J, Avery N.
Affiliation(s): Department of Anesthesiology and Critical Care, Queen's University, Ontario,
Canada. parlowj@post.queensu.ca
Publication date & source: 1999, Can J Anaesth. , 46(8):719-24
PURPOSE: To determine the incidence of post-discharge nausea and vomiting (PDNV)
following outpatient laparoscopic procedures in women, and to assess the efficacy
of the prophylactic administration of promethazine prior to discharge from
hospital.
METHODS: Ninety-five healthy women scheduled for ambulatory laparoscopic
cholecystectomy or gynecological surgery completed this double blind, placebo
controlled study. A standardized fentanyl-propofol-nitrous oxide-isoflurane
anesthetic was used, and all patients received 0.5 mg droperidol i.v.,
intraoperatively. Subjects were randomized to receive 0.6 mg x kg(-1)
promethazine or placebo i.m. prior to transfer from the post-anesthetic recovery
(PAR) unit. The incidence and severity of nausea, pain, and drowsiness were
documented using patient diaries at four time intervals during the first 24 hr
postoperatively using four-point self-assessment scales.
RESULTS: After discharge home, the overall incidence of nausea was 48%, moderate
to severe nausea 30%, vomiting 17% and rescue antiemetic use 28%, with no
difference between those receiving saline or promethazine. The need for
antiemetics in the PAR was associated with subsequent PDNV, with those requiring
PAR antiemetics being four times as likely to vomit after discharge (P = 0.008).
CONCLUSION: Despite the prophylactic administration of 0.5 mg droperidol i.v.,
patients undergoing ambulatory laparoscopic surgery reported a high incidence of
nausea after discharge. Patients requiring antiemetics in the PAR were at higher
risk for PDNV. The incidence of nausea was not altered by prophylactic
administration of 0.6 mg x kg(-1) promethazine i.m. before discharge.
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