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

• 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
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-023-02319-2

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