Combination of droperidol and ondansetron reduces PONV after pediatric strabismus surgery more than single drug therapy

Background: Pediatric strabismus surgery is associated with a very high inc idence of postoperative nausea and vomiting [(PONV) 44-88%]. Droperidol (10 -75 mug kg-') and ondansetron (50-150 mug kg(-1)) have shown variable succe ss in reducing the incidence and severity of PONV. Combination of these two drugs has shown promising results. This randomized, double-blind, placebo- controlled clinical trial was conducted to evaluate the efficacy and safety of the combination of these two drugs in reducing the incidence and severi ty of PONV in pediatric strabismus surgery. Methods: After institutional approval and parental informed consent, 240 ch ildren of ASA physical status I and II of either sex, aged 1-15 years were included in this study None of the children received any premedication and a standardized anesthesia technique was used for all the children. They wer e prospectively randomized to one of the four treatment groups. Group PP re ceived normal saline placebo intravenously after induction and at the end o f the procedure. Group Dr received droperidol 25 mug kg-' after induction a nd normal saline at the end. Group Or received ondansetron 150 mug kg(-1) a fter induction and saline at the end. Group DP received droperidol 15 mug k g-' after induction and ondansetron 100 mug kg(-1) at the end. Results: Combination prophylaxis resulted in a lower incidence of PONV (13% ) as compared to placebo (62.5%, P <0.001), ondansetron (37%, P <0.001), or droycn'dol (32%, P <0.01). Conclusion: Droperidol 15 mug kg(-1) in combination with ondansetron 100 mu g kg-', administered at the induction and end of the operative procedure re spectively, is more effective than either drug given individually in reduci ng the incidence of PONV after strabismus surgery.