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PRE-OPERATIVE ORAL DIMENHYDRINATE REDUCES VOMITING AFTER LAPAROSCOPY

Department of Anesthesiology, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, K7L 2S6.

INTRODUCTION

Postoperative nausea and vomiting (PONV) is a frequent problem following laparoscopic gynecologic surgery and often occurs after hospital discharge. GRAVOL LA^® (GLA) is an oral long-acting formulation containing 25mg of immediate release and 50mg of sustained release dimenhydrinate. There have not been any studies to our knowledge looking at preoperative administration of oral dimenhydrinate.

METHODS

A pre-study survey of our department found that our standard of practice was to administer prophylactic antiemetics to this patient group. Our decision to refrain from a placebo group for ethical reasons was in keeping with other studies¹. Following REB approval and informed consent, 143 women scheduled for elective outpatient gynecologic laparoscopic surgery were randomized in a stratified fashion (past history of PONV): G (n=48) GLA capsule preop and iv placebo prior to induction; D (n=47) placebo capsule preop and iv droperidol 0.625mg prior to induction and GD (n=47) GLA capsule preop and iv droperidol 0.625mg prior to induction. All patients received a standardized anesthetic and ondansetron as a rescue antiemetic in PACU if required. Information regarding nausea and number of emetic episodes was recorded in PACU and in a take-home questionnaire. Data was collected by telephone along with information on patient satisfaction.

RESULTS

The demographics and length of procedure were similar between groups except weight and BMI (P< 0.005). Vomiting (fig. 1) was significantly greater in the D group overall (P<0.009), overall at home (excluding PACU) (P<0.003) and in particular on arrival home (P<0.02). There was no statistical difference in incidence of nausea at any time period or need for rescue medication in PACU. The majority of patients in all groups would consider the same treatment for future procedures.

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The preop administration of a single oral dose of a long acting dimenhydrinate formulation reduced the incidence of vomiting on arrival home and overall when compared to droperidol in patients undergoing elective outpatient gynecologic laparoscopy.

REFERENCES

Anesth Analg 1995; 81:603–7.[Abstract]

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