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ANESTHETIC PHARMACOLOGY

A Randomized Comparison of a Multimodal Management Strategy Versus Combination Antiemetics for the Prevention of Postoperative Nausea and Vomiting

Ashraf S. Habib, MBBCh MSc, FRCA^*, William D. White, MPH^*, Steve Eubanks, MD, Theodore N. Pappas, MD, and Tong J. Gan, MB FRCA, FFARCS(I)^*

Departments of *Anesthesiology and Surgery, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Tong J. Gan, MB, FRCA, FFARCS(I), Department of Anesthesiology, Box 3094, Duke University Medical Center, Durham, NC 27710. Address e-mail to Gan00001{at}mc.duke.edu

A multimodal management strategy for the prevention of postoperative nausea and vomiting (PONV) appears to be superior to single-drug prophylaxis. We tested the hypothesis that a multimodal PONV prophylaxis regimen incorporating total IV anesthesia (TIVA) with propofol and a combination of ondansetron and droperidol is more effective than a combination of these antiemetics in the presence of an inhaled anesthetic. Ninety patients undergoing laparoscopic cholecystectomy were randomized to one of three groups. Group 1 (multimodal group) received TIVA with propofol, droperidol, and ondansetron. Group 2 (combination group) received droperidol and ondansetron with isoflurane and nitrous oxide for the maintenance of anesthesia. Group 3 (TIVA group) received propofol for the induction and maintenance of anesthesia. The complete response rate (no PONV and no rescue antiemetic) at 2 h after surgery was 90%, 63%, and 66% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 2). At 24 h, the complete response rate was 80%, 63%, and 43% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 3). Patient satisfaction was also greater in the multimodal group than in the other two groups in the postanesthesia care unit (P < 0.05). In conclusion, the multimodal management strategy for PONV was associated with a higher complete response rate and greater patient satisfaction when compared with similar antiemetic prophylaxis with inhaled anesthesia or TIVA with propofol.

IMPLICATIONS: A multimodal management strategy for postoperative nausea and vomiting was superior to combination antiemetic prophylaxis with inhaled anesthetic or total IV anesthesia with propofol.

This article has been cited by other articles:

				S. S. Cheng, J. Yeh, and P. Flood Anesthesia Matters: Patients Anesthetized with Propofol Have Less Postoperative Pain than Those Anesthetized with Isoflurane Anesth. Analg., January 1, 2008; 106(1): 264 - 269. [Abstract] [Full Text] [PDF]

				H. White, R. J. Black, M. Jones, and G. C. Mar Fan Randomized comparison of two anti-emetic strategies in high-risk patients undergoing day-case gynaecological surgery Br. J. Anaesth., April 1, 2007; 98(4): 470 - 476. [Abstract] [Full Text] [PDF]

				M. J. Paech, M. W.M. Rucklidge, J. Lain, P. H. Dodd, E.-J. Bennett, and D. A. Doherty Ondansetron and Dexamethasone Dose Combinations for Prophylaxis Against Postoperative Nausea and Vomiting Anesth. Analg., April 1, 2007; 104(4): 808 - 814. [Abstract] [Full Text] [PDF]

				T. J. Gan Risk factors for postoperative nausea and vomiting. Anesth. Analg., June 1, 2006; 102(6): 1884 - 1898. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999