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Prophylactic Diclectin® reduces the incidence of postoperative vomiting

[L’administration prophylactique de Diclectin® réduit l’incidence de vomissements postopératoires]

Brenda K. Reeve, MD^*, Deborah J. Cook, MD, Denise Babineau, MSc, L. Cory Scholes, MD and D. Norman Buckley, MD^*

^* From the Departments of Anesthesia,
Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton;
the Department of Statistics and Actuarial Science, University of Waterloo, Waterloo; and
the Department of Anesthesia, Brantford General Hospital, Brantford, Ontario, Canada.

Address correspondence to: Dr. B.K. Reeve, Department of Anesthesia, St. Joseph’s Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. Phone: 905-522-4941, ext. 3853; Fax: 905-627-2848; E-mail: acescholes{at}yahoo.com

Background: Diclectin® (DCL) is an effective antiemetic used for relief of nausea and vomiting in pregnancy. It is unknown whether DCL is effective in the prevention of postoperative nausea and vomiting (PONV).

Methods: We conducted a randomized, stratified, double-blind placebo-controlled trial to examine the incidence of PONV in women undergoing elective laparoscopic tubal ligation in the day surgery setting. DCL (doxylamine succinate 10 mg and pyridoxine hydrochloride 10 mg) was administered orally the night before surgery, the morning of surgery, and upon hospital discharge. Results: We enrolled 146 women in the trial, 127 of whom were included in the effectiveness analysis and 102 of whom were included in the efficacy analysis. We did not detect a difference in the incidence of nausea and vomiting in the first six hours postoperatively after adjusting for additional antiemetics administered. Patients receiving DCL as compared with placebo were significantly less likely to experience vomiting six to 24 hr postoperatively [5/59 (8.5%) vs 14/55 (25.4%), P < 0.017]. Treated patients tended to return to work earlier than those who received placebo (1.74 vs 3.7 days P = NS).

Conclusion: Perioperative oral DCL reduces the incidence of postoperative vomiting in women undergoing elective laparoscopic tubal ligation, and may accelerate return to work.