Prophylaxis of postoperative nausea and vomiting with oral, long-acting
dimenhydrinate in gynecologic outpatient laparoscopy.
Author(s): Turner KE, Parlow JL, Avery ND, Tod DA, Day AG.
Affiliation(s): Department of Anesthesiology, Queen's University, Kingston General Hospital, 76
Stuart Street, Kingston, Ontario, Canada K7L 2S6. ket1@post.queensu.ca
Publication date & source: 2004, Anesth Analg. , 98(6):1660-4, table of contents
Dimenhydrinate is an inexpensive antiemetic with few side effects available as an
oral, long-acting (LA) formulation (Gravol L/A) containing 25 mg of immediate and
50 mg of sustained release drug. We designed this double-blind comparison trial
to assess the efficacy of dimenhydrinate LA versus droperidol alone and the
combination for prophylaxis of nausea, vomiting, and retching in outpatient
gynecologic laparoscopy. One-hundred-forty-one women were randomized into 3
groups: 1) droperidol (placebo capsule preoperatively and IV droperidol 0.625 mg
before induction), 2) dimenhydrinate LA preoperatively and IV placebo before
induction, or 3) combination. Information regarding nausea, vomiting, retching,
pain, and sedation was recorded in the postanesthesia care unit (PACU) and
collected by telephone for the presence of symptoms: on arrival home; at bedtime;
upon arising, and at lunchtime the following day. The overall incidence of
complete treatment failure (rescue medication in PACU or nausea, vomiting, or
retching at any time point) was 28 of 46 (61%), 28 of 48 (58%), and 22 of 47
(47%); and for treatment failure vomiting (rescue medication in PACU or vomiting
or retching at any time point) was 16 of 46 (35%), 11 of 48 (23%), and 5 of 47
(11%), for the droperidol, dimenhydrinate, and combination groups, respectively
(P = 0.007 for droperidol versus combination). There were no differences in
sedation or pain. Preoperative administration of an oral dose of LA
dimenhydrinate in combination with droperidol when compared with droperidol alone
effectively reduced the incidence of vomiting but not nausea in women undergoing
elective outpatient gynecologic laparoscopy. IMPLICATIONS: Dimenhydrinate is an
inexpensive antiemetic with few side effects available as a long-acting oral
formulation. Women undergoing outpatient gynecologic laparoscopy were given
droperidol, an effective antiemetic, dimenhydrinate alone, or the combination of
the two drugs. Dimenhydrinate plus droperidol significantly reduced the overall
incidence of vomiting, but not nausea, when compared with droperidol alone.
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