Droperidol and/or Ondansetron

Abstract

Our paper is a verification of part of the previously published abstract [1], which consisted of ambulatory patients treated prophylactically with placebo, droperidol, ondansetron, and ondansetron/droperidol. Twenty patients per group during the 24-h study period had postoperative nausea and vomiting of 85%, 50%, 35%, and 15%, respectively [1]. The ondansetron/droperidol combination 15% was more effective than either droperidol 50% or ondansetron 35%. In the interests of cost, to obtain statistical significance by having only two variables to analyze, and to produce timely results, we deemed a third group to be unnecessary. Furthermore, the following reports in the recent literature have recorded the superiority of ondansetron versus droperidol. Paxton et al. [2] studied 118 day-stay patients undergoing laparoscopic gynecological procedures and reported that over 48 hr, the scores for nausea were significantly lower, and the time to the first oral fluids was shorter. Grond et al. [3] used a droperidol dose of 2.5 mg and had a significant reduction in postoperative nausea and vomiting compared with ondansetron 8 mg. However, the incidence of severe drowsiness, restlessness, anxiety, and dizziness was high in those receiving droperidol. There was a 1-h delay in discharge for the droperidol group [3]. Tang et al. [4] concluded that droperidol 0.625 mg did not increase the side effects or delay discharge. In a study of abdominal gynecologic surgery, the risk of vomiting after surgery for 24 h was less with ondansetron 8 mg compared with droperidol 2.5 mg [5]. Pueyo et al. [6] studied 100 women undergoing elective abdominal surgery. Group 1 received placebo, Group 2 received droperidol 2.5 mg with induction then 1.25 mg at 12 h postsurgery, Group 3 received ondansetron 4 mg with induction, and Group 4 was the combination of Groups 2 and 3. Sedation was significantly greater in Groups 2 and 4, but the combination was significantly more effective than each antiemetic alone [6]. Wrench et al. [7] added the droperidol/ondansetron combination to morphine patient-controlled analgesia machines and found significantly less nausea with the combination compared with either drug alone. Another patient-controlled analgesia study compared droperidol with ondansetron and concluded ondansetron to be superior [8]. In our opinion, the addition to our knowledge is the verification of the superior efficacy of the ondansetron/droperidol combination. Secondarily, we have determined that a dose of droperidol 1.25 mg may be given prophylactically without precipitating frequent distressing complications. R. McKenzie, MD N. T. Lim Uy, MD T. J. Riley, MPH D. Hamilton, BS Magee-Womens Hospital; Pittsburgh, PA 15213-3180