THE EFFICACY OF PROPHYLACTIC ONDANSETRON, DROPERIDOL, PERPHENAZINE, AND METOCLOPRAMIDE IN THE PREVENTION OF NAUSEA AND VOMITING AFTER MAJORGYNECOLOGIC SURGERY

The prophylactic antiemetic efficacy of intravenous (IV) ondansetron, droperidol, perphenazine, and metoclopramide was evaluated in a prospe ctive, double-blind study of 360 ASA physical status I-III patients un dergoing total abdominal hysterectomy (TAH). Subjects were randomized to receive TV, one of ondansetron 4 mg, droperidol 1.25 mg, perphenazi ne 5 mg, metoclopramide 10 mg, or placebo prior to induction of anesth esia. Hypotension immediately after administration of metoclopramide w as observed in two patients and four patients given ondansetron develo ped profound systolic hypotension at induction of anesthesia. Twenty-t wo percent of patients receiving droperidol became sedated. Postoperat ively, patients developing severe nausea, retching, or vomiting, defin ed as severe emetic sequelae (SES), were deemed to have failed antieme tic prophylaxis and received antiemetic rescue. A significantly larger number of patients who received TV ondansetron (63%), droperidol (76% ), and perphenazine (70%) were free of SES when compared to placebo (4 3%); P < 0.05. Metoclopramide was ineffective. Although ondansetron, d roperidol, and perphenazine were effective in providing antiemetic pro phylaxis, only IV perphenazine was free of side effects. Hence, we con clude that perphenazine is the best choice for antiemetic prophylaxis after TAH.