Aouad MT, Siddik-Sayyid SM, Taha SK, Azar MS, Nasr VG, Hakki MA, Zoorob DG, Baraka AS. Haloperidol vs. ondansetron for the prevention of postoperative nausea and vomiting following gynaecological surgery
Ondansetron is widely used for the prophylaxis of postoperative nausea and vomiting, while haloperidol is an antiemetic that lacks recent data on efficacy and adverse effects.
In this prospective, randomized, double-blinded study involving 93 females undergoing gynaecological procedures under general anaesthesia, we compared the efficacy and adverse effects of prophylactic haloperidol 1 mg intravenous and ondansetron 4 mg intravenous vs. placebo.
During the overall observation period (0-24 h), in the haloperidol, ondansetron and placebo groups respectively, the incidence of nausea and/or vomiting was 40.7% (11/27), 48.2% (13/27) and 55.5% (15/27), and the need of rescue antiemetics was 22.2% (6/27), 44.4% (12/27) and 40.7% (11/27), with P values >0.05 among the three groups. During the early observation period (0-2 h), in the haloperidol, ondansetron and placebo groups respectively, the incidence of nausea and/or vomiting was 13.7% (4/29), 26.6% (8/30) and 43% (13/30), and the need for rescue antiemetics was 6.8% (2/29), 26.6% (8/30) and 36.6% (11/30). Between haloperidol and placebo groups, the P value was 0.04 for nausea and/or vomiting, and was 0.01 for rescue antiemetics, in addition to lower nausea scores (P = 0.03). During the late observation period (2-24 h), no significant difference was shown among the three groups.
The prophylactic administration of 1 mg intravenous haloperidol or 4 mg ondansetron, in female patients undergoing gynaecological surgery, did not improve the overall incidence of nausea and/or vomiting vs. placebo. However, haloperidol 1 mg proved to be an effective antiemetic in the early observation period without significant adverse effects.
"The risk of developing Torsades de Pointes is increased in patients receiving doses of 35 mg/d or higher. Haloperidol at doses 1-2 mg showed no significant effect of QT interval. In this study, none of the patients showed extrapyramidal or psychomotor side effects attributable to the use of haloperidol. "
[Show abstract][Hide abstract] ABSTRACT: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery.
Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6(th) post-operative hour.
The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05).
Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.
[Show abstract][Hide abstract] ABSTRACT: Introduction: The 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. Methodology: The 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. Results: Ten 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. Discussion: This systematic review supports the effectiveness of haloperidol as prophylactic treatment of PONV. No statistically significant differences were found as compared against ondansetron or droperidol.
Revista Colombiana de Anestesiologia 01/2013; 41(1):34–43. DOI:10.1016/j.rcae.2012.09.004
"Haloperidol, that is a tranquilizer with a mechanism similar to droperidol, has prophylactic effect on PONV.[8–10] The anti-emetic effect of haloperidol was due to its central effect at dopamine D2 receptors.[25–27] "
[Show abstract][Hide abstract] ABSTRACT: The efficacy of using midazolam or haloperidol for prevention of postoperative nausea and vomiting (PONV) has been investigated before. The main object of the present study was to evaluate the anti-emetic effects of combining administration of intravenous haloperidol with intravenous midazolam on PONV in patients underwent middle ear surgery in comparison with using each drug alone.
Study design was randomized, double-blind, placebo-controlled. 80 patients, aged 18-60 years, scheduled for middle ear surgery in Kashani Hospital Medical Center under general anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into 4 groups of 20 each and received haloperidol 2 mg i.v. (Group H); midazolam 2 mg i.v. (Group M); haloperidol 2 mg plus midazolam 2 mg i.v. (Group HM); saline i.v. (Group C). The incidences of PONV and complete response were evaluated at 0-2 hours after arrival to the PACU and 2-24 hours after arrival to the ward in 4 groups.
Patients in group HM had significantly lower incidence of PONV compared with groups H, M, and C throughout 0-24 h (P<00.5). The HM group had the lowest incidence of PONV (0-2, 2-24, and 0-24 h) and the highest incidence of complete response. Postoperative anti-emetic requirement was significantly less in group HM compared with group M or H (P<0.05).
Combine administration of haloperidol 2 mg plus midazolam 2 mg significantly reduced PONV better than using each drug alone in patients underwent middle ear surgery under general anesthesia.
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