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PAIN MEDICINE

The Antiemetic Efficacy of Droperidol Added to Morphine Patient-Controlled Analgesia: A Randomized, Controlled, Multicenter Dose-Finding Study

Xavier Culebras, MD^*, Jean-Baptiste Corpataux, MD, Giovanni Gaggero, MD, and Martin R. Tramèr, MD DPhil^*

*Division d’Anesthésie, Département APSIC (Anesthéie, Pharmacologie et Soins Intensif de Chirurgie), Hôpitaux Universitaires de Genève, Genève, Switzerland; Service d’Anesthésie, Hôpital de La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland; and Service d’Anesthésie, Hôpital Sud Fribourgeois, Riaz, Switzerland

Address correspondence and reprint requests to X. Culebras, MD, Division of Anaesthesiology, Rue Micheli du Crest 24, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland. Address e-mail to xavier.culebras{at}hcuge.ch

The antiemetic dose response of droperidol when it is added to patient-controlled analgesia with morphine is not well known. We randomly allocated adults who received postoperative morphine patient-controlled analgesia (1-mg bolus, 5-min lockout) to one of four regimens: no droperidol (control) or 5, 15, or 50 µg of droperidol per milligram of morphine. Efficacy and adverse effects were recorded during 24 h and were analyzed with number needed to treat (NNT) and number needed to harm with 95% confidence intervals. Data from 82 controls, 82 patients receiving droperidol 5 µg, 82 receiving droperidol 15 µg, and 83 receiving droperidol 50 µg were analyzed. Average consumption of droperidol per 24 h was 0.2 mg with the 5-µg regimen, 0.61 mg with the 15-µg regimen, and 2.04 mg with the 50-µg regimen. In controls, the incidence of nausea was 48.8%; with droperidol 5 µg, it was 42.7% (NNT compared with control, 16 [95% confidence interval, 4.7 to -11]); with 15 µg, it was 32.9% (NNT, 6.3 [3.3–100]); and with 50 µg, it was 21.7% (NNT, 3.7 [2.4 to 7.6]). In controls, the incidence of vomiting was 24.4%; with droperidol 5 µg, it was 23.2% (NNT compared with control, 82 [7 to -8.5]); with 15 µg, it was 22.0% (NNT, 41 [6.5 to -9.6]); and with 50 µg, it was 12% (NNT, 8.1 [4.2–142]). In controls, the incidence of pruritus was 12.2%; with droperidol 5 µg, it was 6.1% (NNT compared with control, 16 [6.7 to -37]); and with 15 and 50 µg, it was 2.4% (NNT, 10 [5.7–52]). In controls, the incidence of sedation was 2.4%; with droperidol 5 µg, it was 8.5% (number needed to harm (NNH) compared with control, 16 [7.7 to -123]); with 15 µg, it was 6.1% (NNH, 27 [10 to -40]); and with 50 µg, it was 18.1% (NNH, 6.4 [4.1–15]). There were no extrapyramidal symptoms and no cardiac adverse events. There was no difference in patient satisfaction. The optimal antiemetic dose of droperidol is 15–50 µg/mg of morphine. Larger doses may have more antivomiting efficacy but are likely to be unacceptably sedating.

IMPLICATIONS: In a patient-controlled analgesia (PCA) pump, droperidol 5 µg/mg of morphine is not antiemetic, antipruritic, or sedative. Droperidol 15 µg shows some antiemetic efficacy, is antipruritic, and is not sedative. Droperidol 50 µg is clearly antiemetic, is no more antipruritic than 15 µg, and is clearly sedative. In a PCA pump with morphine, the optimal dose of droperidol is 15–50 µg/mg of morphine.

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