A small dose of droperidol decreases postoperative nausea and vomiting in adults but cannot improve an already excellent patient satisfaction

Background: We evaluated whether or not 1) a routine prophylaxis with 20 mu g . kg(-1) body weight of droperidol would efficiently prevent postoperativ e nausea and vomiting (PONV) after elective surgery in adults and 2) an eff icient prophylaxis would improve patient satisfaction. Methods: With approval of the local ethics committe and after having obtain ed informed written consent, 1334 patients in a randomised, single-blinded fashion either received droperidol (group 1, n=655) or saline intravenously (group 2, n=669) 20 min before the end of a standard O-2/N2O/fentanyl/isof lurane anaesthesia of at least 30 min duration. End points: incidence of PO NV during the first 24 h; individual episodes of nausea or vomiting, overal l patient satisfaction with the procedure. Results: Compared to saline, intravenous injection of droperidol substantia lly and significantly reduced the incidence of PONV from 30% to 20% (P<0.00 01). Women suffered three times more frequently from PONV (10.5% vs. 30%, P <0.0001). Droperidol significantly reduced the incidence of PONV from 35.4% to 24.4% in women (relative risk reduction: 31%, P=0.0002), but not in men (13.1% vs. 8.2%, relative risk reduction: 37%, P= 0.159) - without impact on overall patient satisfaction (98.8% vs. 97.1%, P=0.439). Distribution of surgical procedures, sex, age, height, weight and anaesthetic duration wer e not different between groups. To prevent one woman from suffering PONV, n ine had to be treated prophylactically at an individual drug cost (German p rices) of about EURO 0.80 per woman. Conclusion: Routine PONV prophylaxis with 20 mug . kg(-1) body weight of dr operidol is cost-efficient and appropriate in women but not in men.