Antiemetic prophylaxis with droperidol in morphine-based intravenous patient-controlled analgesia: a propensity score matched cohort study

Background There are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to evaluate the antiemetic benefits and sedation effects of droperidol in morphine-based IV-PCA. Methods Patients who underwe...

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Published in:BMC anesthesiology 2023-10, Vol.23 (1), p.1-351, Article 351
Main Authors: Tan, Jia Qi, Wu, Hsiang-Ling, Wang, Yi-Chien, Cata, Juan P, Chen, Jui-Tai, Cherng, Yih-Giun, Tai, Ying-Hsuan
Format: Article
Language:English
Subjects:
Analgesia
Analgesics
Analysis
Anti-inflammatory agents
Antiemetics
Bupivacaine
Cohort analysis
Disease prevention
Droperidol
Drug dosages
Fentanyl
General anesthesia
Intravenous administration
Medical centers
Medical personnel
Medical records
Morphine
Narcotics
Nausea
Opioids
Pain
Pain perception
Patients
Postoperative nausea and vomiting
Prevention
Prophylaxis
Regression analysis
Retching
Review boards
Surgery
Vomiting
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Summary:Background There are limited real-world data regarding the use of droperidol for antiemetic prophylaxis in intravenous patient-controlled analgesia (IV-PCA). This study aimed to evaluate the antiemetic benefits and sedation effects of droperidol in morphine-based IV-PCA. Methods Patients who underwent major surgery and used morphine-based IV-PCA at a medical center from January 2020 to November 2022 were retrospectively analyzed. The primary outcome was the rate of any postoperative nausea and/or vomiting (PONV) within 72 h after surgery. Propensity score matching was used to match patients with and without the addition of droperidol to IV-PCA infusate in a 1:1 ratio. Multivariable conditional logistic regression models were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results After matching, 1,104 subjects were included for analysis. The addition of droperidol to IV-PCA reduced the risk of PONV (aOR: 0.49, 95% CI: 0.35-0.67, p < 0.0001). The antiemetic effect of droperidol was significant within 36 h after surgery and attenuated thereafter. Droperidol was significantly associated with a lower risk of antiemetic uses (aOR: 0.58, 95% CI: 0.41-0.80, p = 0.0011). The rate of unintentional sedation was comparable between the patients with (9.1%) and without (7.8%; p = 0.4481) the addition of droperidol. Postoperative opioid consumption and numeric rating scale acute pain scores were similar between groups. Conclusions The addition of droperidol to IV-PCA reduced the risk of PONV without increasing opiate consumption or influencing the level of sedation. However, additional prophylactic therapies are needed to prevent late-onset PONV. Keywords: Opioids, Postoperative nausea and vomiting, Prevention, Prophylaxis, Retching
ISSN:1471-2253
1471-2253
DOI:10.1186/s12871-023-02319-2