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Dagtekin O, Wiese P, Wolter K, Hermann MM, Pietruck C, Kampe S. Haloperidol versus haloperidol plus ondansetron for the prophylaxis of postoperative nausea and vomiting after ophthalmologic surgery

Department of Anaesthesiology, University of Cologne, Cologne, Germany.
Pharmacology (Impact Factor: 1.58). 02/2009; 83(4):205-10. DOI: 10.1159/000196812
Source: PubMed

ABSTRACT In this prospective, randomized, and double-blinded study we investigated the efficacy of haloperidol (10 microg/kg) and the combination of haloperidol (10 microg/kg) with ondansetron (0.1 mg/kg) for the prophylaxis of postoperative nausea and vomiting (PONV) after ophthalmologic surgery.
60 patients (ASA status 1-3) with risk factors for PONV (female, non-smoker, motion sickness or PONV in history, opioids for postoperative analgesia) undergoing retinal or strabismus surgery were included into the study and randomised to the haloperidol group (H-Group) or the haloperidol-ondansetron group (H/O-Group). 20 min before the end of anaesthesia the study medication was given. Nausea, vomiting, pain scores, and adverse events were assessed postoperatively over 24 h.
The incidence of PONV was lower for the H/O-Group (23 vs. 57% for the H-Group). Especially the incidence of vomiting was reduced for the H/O-Group (7 vs. 27% in the H-Group). No significant differences could be detected regarding adverse events.
The single use of haloperidol for the prophylaxis of PONV is doubtful. Better results were obtained with the combination therapy of haloperidol with ondansetron, especially for vomiting.

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    ABSTRACT: IntroductionThe effectiveness of haloperidol for the prophylaxis of postoperative nausea and vomiting (PONV) has been proven in prior trials summarized by Buttner in 2004. New evidence has surfaced since then. Our objective is thus to update the current knowledge on the topic. A systematic review and a meta-analysis were performed, in order to determine the effectiveness and safety of the use of haloperidol as prophylaxis for PONV.MethodologyThe systematic search, the selection of relevant articles, the extraction of data, the critical analysis of the primary studies, the comparisons and analyses were all based on the recommendations of the Cochrane Collaboration and using RevMan5 software.ResultsTen controlled clinical trials published between 1962 and 2010, that included 2,711 patients, met the selection criteria. As compared against droperidol (RR: 0.97; 95% CI: 0.52-1.79) and against ondansetron (RR: 1.24; 95% CI: 0.66-2.35), no differences were found in terms of effectiveness after 24 hours. A protective effect against PONV associated with the use of haloperidol at varying doses, routes of administration and timing of administration was observed as compared with placebo. No significant increases in adverse events have been reported.DiscussionThis systematic review supports the effectiveness of haloperidol as prophylactic treatment of PONV. No statistically significant differences were found as compared against ondansetron or droperidol.Conclusions Haloperidol is an effective prophylactic drug for PONV.
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    ABSTRACT: IntroductionThe effectiveness of haloperidol for the prophylaxis of postoperative nausea and vomiting (PONV) has been proven in prior trials summarized by Buttner in 2004. New evidence has surfaced since then. Our objective is thus to update the current knowledge on the topic. A systematic review and a meta-analysis were performed, in order to determine the effectiveness and safety of the use of haloperidol as prophylaxis for PONV.MethodologyThe systematic search, the selection of relevant articles, the extraction of data, the critical analysis of the primary studies, the comparisons and analyses were all based on the recommendations of the Cochrane Collaboration and using RevMan5 software.ResultsTen controlled clinical trials published between 1962 and 2010, that included 2,711 patients, met the selection criteria. As compared against droperidol (RR: 0.97; 95% CI: 0.52–1.79) and against ondansetron (RR: 1.24; 95% CI: 0.66–2.35), no differences were found in terms of effectiveness after 24 h. A protective effect against PONV associated with the use of haloperidol at varying doses, routes of administration and timing of administration was observed as compared with placebo. No significant increases in adverse events have been reported.DiscussionThis systematic review supports the effectiveness of haloperidol as prophylactic treatment of PONV. No statistically significant differences were found as compared against ondansetron or droperidol.Conclusions Haloperidol is an effective prophylactic drug for PONV.ResumenIntroducciónLa efectividad del haloperidol en la profilaxis para náuseas y vómito postoperatorios (NVPO) ha sido demostrada en estudios previos resumidos en 2004 por Buttner. Desde entonces ha surgido nueva evidencia, por lo cual nuestro objetivo es actualizar el estado presente del conocimiento en este tema. Se realizó una revisión sistemática y metaanálisis con el fin de aproximarnos a la efectividad y a la seguridad del uso de haloperidol en la profilaxis de NVPO.MetodologíaLa búsqueda sistemática, la selección de artículos relevantes, la extracción de datos, el análisis crítico de los estudios primarios, las comparaciones y los análisis se realizaron con base en las recomendaciones de Cochrane Collaboration y a través del software RevMan5.ResultadosDiez experimentos clínicos controlados, publicados entre 1962 y 2010, que incluyen 2.711 pacientes, cumplen los criterios de selección. Comparado con el droperidol (RR: 0,97; IC 95%: 0,52-1,79) y con el ondansetrón (RR: 1,24; IC 95%: 0,66-2,35), no se encontraron diferencias en la efectividad a las 24 h. Se evidencia un efecto protector contra NVPO asociado al uso de haloperidol en diferentes dosis, vías de administración y momentos de administración al comparar frente a placebo. No hay reporte de aumento de efectos adversos de forma significativa.DiscusiónLa efectividad de haloperidol como profilaxis de NVPO queda sustentada por esta revisión sistemática sin que se logren identificar diferencias estadísticamente significativas cuando se compara con el ondansetrón o el droperidol.ConclusionesEl haloperidol es un medicamento efectivo y seguro para la profilaxis de NVPO.
    Revista Colombiana de Anestesiologia 01/2013; 41(1):34–43. DOI:10.1016/j.rcae.2012.09.004
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