• Eur J Anaesthesiol · Jun 2012

    Review Meta Analysis

    Low-dose droperidol (≤1 mg or ≤15 μg kg-1) for the prevention of postoperative nausea and vomiting in adults: quantitative systematic review of randomised controlled trials.

    • Isabelle Schaub, Christopher Lysakowski, Nadia Elia, and Martin R Tramèr.
    • Department of Anaesthesiology, Clinique Sainte Anne Saint Remi, 66 Boulevard Jules Graindor, Brussels, Belgium schaubisabelle@hotmail.com
    • Eur J Anaesthesiol. 2012 Jun 1;29(6):286-94.

    ContextDroperidol is widely used for the prevention of postoperative nausea and vomiting (PONV) in European countries. It is unclear how efficacious low-dose droperidol is in the prevention of PONV.ObjectivesTo test the efficacy of low-dose droperidol in the prevention of PONV in adults and to test for dose-responsiveness.DesignSystematic review of randomised controlled trials with meta-analyses.Data SourcesComprehensive search in electronic databases (Medline, Embase, Central) up to June 2011. Additional trials were obtained from bibliographies of retrieved reports. No language restriction was applied.Eligibility CriteriaRandomised trials testing prophylactic intravenous droperidol ≤1 mg or ≤15 μg kg compared with placebo (or no treatment) in adults undergoing general anaesthesia and reporting on PONV.ResultsWe analysed 25 trials (2957 patients). Doses varied from 0.25 to 1.0 mg. For prevention of early nausea (within 6 h postoperatively), relative risk (RR) was 0.45 (95% CI, 0.35 to 0.58); number needed to treat (NNT) was 7, 4, and 2 for low, medium and high baseline risk (i.e. control event rate 25, 50, 75%). For prevention of early vomiting, RR was 0.65 (95% CI, 0.57 to 0.74), NNT 11, 6, and 4. For prevention of late nausea (within 24 h), RR was 0.74 (95% CI, 0.62 to 0.87), NNT 15, 8, and 5. For prevention of late vomiting, RR was 0.61 (95% CI, 0.47 to 0.80), NNT 10, 5, and 3. Droperidol decreased the risk of headache but increased the risk of restlessness. For these outcomes there was no evidence of dose-responsiveness. There were no differences in the incidences of sedation or dizziness. Two patients receiving droperidol 0.625 mg had extrapyramidal symptoms. Cardiac toxicity data were not reported.ConclusionProphylactic doses of droperidol of 1 mg or below are antiemetic. Because adverse drug reactions are likely to be dose-dependent, there is an argument to stop using doses of more than 1 mg.

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