Epidural Droperidol Research Articles

A Patient Who Developed Extrapyramidal Symptoms after Continuous Epidural Droperidol Administration But Not after Its Intravenous Administration

A Patient Who Developed Extrapyramidal Symptoms after Continuous Epidural Droperidol Administration But Not after Its Intravenous Administration

Postoperative neuroleptic malignant syndrome-like symptoms improved with intravenous diazepam: a case report

A 75-year-old man who had undergone left upper lobectomy of the lung exhibited fever and insomnia on postoperative day (POD) 1 and muscle rigidity, autonomic instability, and somnolence on POD2 after epidural administration of droperidol and withdrawal of oral etizolam. He had not been known to have any neuromuscular diseases or psychiatric diseases, with the exception of anxiety disorder. Brain computed tomography did not show cerebrovascular disorders. Consultation with a neurologist led to a suspicion of neuroleptic malignant syndrome (NMS). Epidural droperidol was stopped and administration of dantrolene was initiated. These measures, in addition to supportive care, only partially ameliorated the symptoms of the patient, and consciousness disturbance developed; the patient finally became comatose on POD3. However, intravenous diazepam (10 mg) improved his symptoms abruptly. Subsequently, oral administration of lorazepam (1 mg/day) was started, and his symptoms disappeared within 2 days (POD5). Although NMS-like symptoms are rarely seen in clinical practice, some factors may induce it during the perioperative period, such as the administration of dopamine antagonists and the cessation of benzodiazepines. Intravenous diazepam is an effective treatment in cases with suspected gamma-aminobutyric acid (GABA) hypoactivity at the GABAA receptor induced by the cessation of benzodiazepines.

Reevaluation of Epidural Droperidol as Prophylaxis Against Postoperative Nausea and Vomiting after Gynecological Surgery

Reevaluation of Epidural Droperidol as Prophylaxis Against Postoperative Nausea and Vomiting after Gynecological Surgery

Antipruritic and antiemetic effect of epidural droperidol

This study was designed to investigate whether single epidural droperidol or continuous epidural droperidol inhibit pruritus and postoperative nausea and vomiting induced by postoperative continuous epidural fentanyl administration, and to identify the optimal method of administering epidural droperidol. 120 ASA I-II patients undergoing subtotal gastrectomy with general anaesthesia combined with epidural anaesthesia were randomly allocated into three groups: control (no droperidol), single injection (droperidol 2.5 mg) and continuous group (droperidol 2.5 mg 2 day(-1)). Postoperatively the frequency and severity of pruritus and postoperative nausea and vomiting in all groups were compared during 48 h. The frequency and severity of pruritus was significantly lower in both single injection and continuous groups than control group after epidural fentanyl administration (P < 0.05). The frequency and severity of postoperative nausea and vomiting was significantly lower in single injection group than control group after epidural fentanyl administration (P < 0.05). Epidural continuous droperidol is effective for reducing pruritus, and single epidural droperidol injection is effective for reducing pruritus and postoperative nausea and vomiting induced by postoperative continuous epidural fentanyl analgesia.

The Optimal Administration of Epidural Droperidol to Reduce the Side Effects of Epidural Opioid

Background: Epidural opioids are used for the treatment of postoperative pain, but the incidence of side effects like nausea, vomiting, and pruritus is high. The aim of this study was to determine the optimal method for administering epidural droperidol to reduce the side effects of epidural opioids. Methods: A randomly sampled group of 145 patients that had undergone abdominal or lower leg surgery under general anesthesia were divided into the four groups. All patients received morphine 4 mg, fentanyl 500g and 0.2% ropivacaine 100 ml using a 2-day epidural infusion pump, and morphine 1 mg, fentanyl 50 g and 0.2% ropivacine 10 ml by epidural bolus. Group 1 patients (control group, n=40) did not receive epidural droperidol. Group 2 patients (n =35) received 2.5 mg of droperidol as an epidural bolus. Group 3 patients (n=35) received 2.5mg of droperidol as a continuous infusion. Group 4 patients (n=35) received 1.23mg of droperidol as an epidural bolus and 1.25 mg of droperidol as a continuous infusion simultaneously, Nausea, vomiting, and pruritus were assessed and recorded by a blind observer 1, 6, 24, and 48 hours after the bolus epidural administration of droperidol. Results: There was no significant difference between the four groups in terms of the intensity of sedation, nausea, vomiting, and pruritus. The incidence of nausea and vomiting in groups 2,3, and 4 at 1 hour, in groups 2 and 4 at 6 hours, and in groups 3 at 48 hours was significantly lower than in control group. The incidences of pruritus in groups 2,3, and 4 at 6 hours, and in groups 3 and 4 at 24 and 48 hours were significantly less than that of control group. Conclusions: Epidural bolus droperidol is effective at reducing nausea, and vomiting during the early postoperative stage. Contimuous epidural droperidol is also effective at reducing the pruritys during the late postoperative stage.

Continuous epidural, not intravenous, droperidol inhibits pruritus, nausea, and vomiting during epidural morphine analgesia

Purpose: To investigate whether continuous epidural droperidol and intravenous (IV) intraoperative droperidol inhibit pruritus and postoperative nausea and vomiting (PONV) during epidural morphine analgesia. Design: Randomized, double-blinded, controlled study. Setting: Metropolitan cancer center. Patients: 120 ASA physical status I and II patients undergoing thoracic or abdominal surgery with general anesthesia combined with epidural anesthesia. Interventions: Patients received an intraoperative epidural injection of 2 mg morphine hydrochloride, followed postoperatively by a continuous epidural infusion of morphine hydrochloride 4 mg/day for 4 days. Patients were randomly allocated to four groups: Group A = control group, Group B = intraoperative single IV injection of droperidol (2.5 mg), Group C = postoperative continuous epidural droperidol infusion (2.5 mg/day), and Group D = intraoperative IV injection of droperidol (2.5 mg) and postoperative continuous epidural droperidol infusion (2.5 mg/day). Measurements and Main Results: The frequency and severity of pruritus and PONV in each group were evaluated during the postoperative period. Continuous epidural infusion of droperidol significantly reduced the frequency and severity of pruritus and PONV induced by epidural morphine without causing significant side effects. Intraoperative single IV injection of droperidol was effective for PONV (p < 0.05) but not for pruritus. Conclusion: Postoperative epidural droperidol infusion significantly decreased both the frequency and severity of pruritus and PONV during postoperative continuous epidural morphine analgesia. IV intraoperative droperidol significantly reduced the frequency and the severity of PONV but not pruritus.

The Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

The Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

▪ The Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

▪ The Inhibition of Epidural Morphine-Induced Pruritus by Epidural Droperidol

PATIENT CONTROLLED EPIDURAL ANALGESIA (PCEA) WITH BUPRENORPHINE AND DROPERIDOL IN CHILDREN

S228 Epidural administration of droperidol has been shown to enhance the analgesic effect of epidural morphine with reduced adverse effects in adults [1]. Epidural buprenorphine is being used to provide postsurgical pain control [2]. The present study assessed whether the addition of epidural droperidol would influence the effect of epidural buprenorphine by Patient Controlled Epidural Analgesia (PCEA) in pediatric patients. METHOD: Forty children of ASA class I-II and age 5-11 who were scheduled for lower extremity surgeries received placement of epidural catheter at L2-4 after ketamin 5 mg/kg I.M. Epidural anesthesia was maintained with 1.5% lidocaine. After surgery when patients were fully awake and complained of pain they were divided in double blind and randomized fashion innnto 2 equal groups with Group A receiving PCEA of buprenophine 0.0012% in bupivacaine 0.1% and Group B receiving PCEA of buprenorphine 0.0012% + droperidol 0.005% + bupivacaine 0.1%. The PCEA was administered by Graseby-9300 pump with a loading dose of 0.1 ml/kg, continuous infusion of 0.05 ml/kg/hr and a PCA dose of 0.05 ml/kg with a 30 min lock out interval. Vital signs, pain intensity assessment by faces pain scale [3], sedation by Ramsay scale [4], frequency and dose of PCEA and adverse effects were recorded for 24 hr. post operatively. RESULT: The demographic data of the 2 groups were comparable without significant difference. Both groups obtained effective pain relief with an average value of the summed VAS 1.7 for Group A and 1.5 for Group B. However, Group B had significantly lower number of PCEA doses 1.44 +/- 0.18 vs 2.65 +/- 0.38) and less total 24 hr. dose used than those of Group B (13.23 +/- 3.26 ml vs 20.38 +/- 5.35 ml) (p<0.01). This seems to indicate that there is a potentiating effect of the epidural buprenorphine analgesia by droperidol. The incidence of nausea/vomiting was found to be 5/20 in Group A vs 1/20 in Group B. Patients in Group B showed a higher sedation score of 3.7 +/- 0.62 vs 2.7 +/- 0.45 in Group A (p<0.05). Urinary retention was not assessed due to the use of indwelling Foley catheters in some of the patients and there was no other significant adverse reactions observed. DISCUSSION: The addition of epidural droperidol appears to potentiate the analgesic effect and reduce the adverse effect of epidural burenorphine which can be used safely to provide effective relief of post surgical pain by PCEA method in children.

A Study of Epidural Droperidol Dosage for Reducing Nausea, Vomiting and Pruritus Due to Epidural Morphine and Fentanyl in Epidural Pain Management of Patients Undergoing Vaginal Total Hysterectomy

A Study of Epidural Droperidol Dosage for Reducing Nausea, Vomiting and Pruritus Due to Epidural Morphine and Fentanyl in Epidural Pain Management of Patients Undergoing Vaginal Total Hysterectomy

Droperidol and the Side Effects of Epidural Morphine After Cesarean Section

Epidural morphine produces analgesia with a high incidence of side effects that include pruritus, nausea, and vomiting.This study investigated whether epidural or IV droperidol could alleviate these symptoms. In a prospective, double-blind, randomized, controlled trial, 97 pregnant women undergoing cesarean section were randomly assigned to three groups. All received standard continuous epidural anesthesia. After delivery, each received 5 mg of epidural morphine with either no droperidol injection, 2.5 mg of epidural droperidol, or 2.5 mg of IV droperidol. The incidence, onset, duration, and severity of pruritus; the onset and severity of pain; and satisfaction were similar for each group, but the incidence and severity of nausea and vomiting was lower in the group that received IV droperidol (P < 0.01). Sedation was minimal throughout the study. Thus, epidural droperidol failed to alleviate the side effects caused by epidural morphine, but IV droperidol reduced both the incidence and severity of nausea and vomiting. These results suggest that droperidol acts systemically to counter the effects of epidural morphine but that it is not entirely effective. Implications: A single dose of epidural morphine provides long-lasting pain relief for women who have undergone cesarean section, but it has some troublesome side effects (itching, nausea, vomiting). We performed a prospective, randomized, controlled trial in 97 such women to study whether droperidol could reduce these side effects. We found that IV droperidol reduced nausea and vomiting but did not prevent itching, and that epidural droperidol failed to prevent all side effects. (Anesth Analg 1998;86:532-7)

Epidural administration of droperidol suppresses cisplatin-induced emesis: preliminary findings.

To evaluate the antiemetic effect of the epidural administration of droperidol on cisplatin-induced emesis, nine adult gastric cancer patients receiving intraoperative cisplatin chemotherapy were studied. After removal of the stomach, 0.05 mg/kg droperidol with 5 ml saline was injected into the epidural space through the epidural catheter. Thirty minutes later, 60 mg/m2 cisplatin was administered intravenously over 1h. Subsequently, the same dose of droperidol was also injected epidurally every 6 h for 18 h. Postoperatively, the antiemetic effect was evaluated until 30 h after the first epidural droperidol. As a result, all patients expressed almost complete antiemesis until 25 h. After 26 h, some patients complained of mild emesis. No potential side effects, such as hypotension, consciousness disturbance, and extrapyramidal signs, were noticed. Therefore, the present pilot study implies that a sole epidural administration of droperidol remarkably suppresses cisplatin-induced emesis.

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease. Three treatment groups were constituted: one with 5.0 mg morphine and 2.5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5.0 mg morphine and 0.1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation. In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group. In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.

Epidural Droperidol and Morphine for Postoperative Pain

Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To assess a potential reduction of opioid side effects by droperidol, 4 mg morphine with either placebo or 2.5 mg droperidol was injected epidurally in a double-blind, randomized, postoperative trial. Forty patients undergoing hip replacement surgery were studied. The overall incidence of side effects during the first 24 h in the group receiving droperidol and morphine was less than 50% of that in the group receiving placebo and morphine (P less than 0.008). Pruritus, emesis, nausea, urinary retention, and hypotension were diminished in the group with droperidol. No significant differences in duration or quality of analgesia were seen. Epidural injection of droperidol did not result in any local or systemic side effects.

Reduction of side-effects of epidural morphine with epidural droperidol

Reduction of side-effects of epidural morphine with epidural droperidol

こう門手術後の硬膜外鎮痛薬（ブプレノルフィン，ドロペリドール）の有用性と問題点

肛門疾患手術後, 硬膜外鎮痛薬としてブプレノルフィン0.1-0.15mgを生食10mlと共に投与したもの (100例 ; IIa群), これにドロペリドール2.5mg併用したもの (100例 ; IIb群) および無処置のもの (150例 ; I群) の3群間で鎮痛効果や付随する合併症について比較検討した. 硬膜外投与は術直後より48時間後まで約12時間毎に行い, 疼痛時には主としてメフェナム酸を内服投与した.術後48時間にわたり鎮痛薬を服用しなかったのは, I群, IIa群, IIb群それぞれ35, 62, 79%, 鎮痛薬内服の有無にかかわらず, 術翌日朝ほとんど無痛であったのはそれぞれ27, 55, 60%と硬膜外鎮痛薬の有用性が確かめられた. またドロペリドール併用により鎮痛効果が増強することが示唆された. 悪心はI群, IIa群, IIb群それぞれ6, 11, 3%に生じ, ドロペリドールの悪心発現抑制作用がみられた. しかし, 硬膜外鎮痛薬による軽度排尿障害や一過性発熱例などの問題点もみられた.

Potentiation of epidural opioids with epidural droperidol. A one year retrospective study.

During a period of one year, 119 patients with chronic pain received injections of opioids via a catheter inserted in the lumbar epidural space. Twenty-three patients (19%) showed evidence of tolerance and were given droperidol 1.25-5.0 mg epidurally. In 20 patients in this study, there was a significant reduction in the number of epidural opioid injections. Six patients complained of excessive sedation, which disappeared when the dose of droperidol was reduced, although this did not affect the analgesia. One patient given an accidental overdose of droperidol developed reversible Parkinsonism. It is concluded that epidural administration of the dopamine antagonist droperidol may be beneficial as supplementary medication to epidural opioids when tolerance develops.