Anesth Analg 2000;91:763
© 2000 International Anesthesia Research Society
LETTERS TO THE EDITOR
The Prophylactic Antiemetic Efficacy of Naloxone During Patient-Controlled Opioid Analgesia
Frédéric Pastureau, MD,
Alain C. Van Elstraete, MD, and
Thierry Lebrun, MD
Service Anestheésie-Réanimation Clinique Saint-Paul Clairière, Fort de France, Martinique
To the Editor: We read with great interest the article by Tramèr et al. (1) who compared prophylactic antiemetic medications in the postoperative patient-controlled analgesia (PCA)-setting with opioids. Droperidol, ondensetron, hyoscine TTS, tropisetron, metoclopramide, propofol, and promethazine were analyzed. The authors found that droperidol is statistically much more effective than placebo without evidence of dose responsiveness and that there is a lack of evidence for other antiemetics.
It would have been interesting to include naloxone in this comparative study. Indeed, Gan et al. (2) showed that naloxone is effective in preventing PCA opioid-related side effects such as pruritus, nausea, and vomiting, without reducing the duration and quality of morphine-related analgesia. Furthermore, naloxone infusion at a rate of 0.25 µg · kg-1 · h-1 not only attenuates these side effects, but appears to reduce postoperative opioid requirements. Finally, the addition of naloxone directly into morphine PCA is chemically and physically compatible.
Footnotes
Dr. Tramèr did not wish to respond to this letter.
References
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Tramèr MR, Walder B. Efficacy and adverse effects of prophylactic antiemetic during patient-controlled analgesia therapy: a quantitative systematic review. Anesth Analg 1999; 88: 1354–61.[Abstract/Free Full Text]
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Gan Tong J, et al. Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate. Anesthesiology 1997; 87: 1075–81.[Web of Science][Medline]
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